KELLY MOORE NP
NPI 1104303072
Nurse Practitioner - Psychiatric/Mental Health in Boise, ID

Q: What is Kelly Moore's NPI number?

The NPI number for Kelly Moore is 1104303072. It was assigned to this individual provider in the NPPES registry on July 24, 2018.

Q: What is Kelly Moore's specialty?

The primary specialty registered for this NPI is Nurse Practitioner, specializing in Psychiatric/Mental Health, with taxonomy code 363LP0808X.

Q: When was this NPI record last updated?

The NPPES record for Kelly Moore was last updated on March 21, 2023. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 3 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.

Active since July 24, 2018PECOS EnrolledAccepts Medicare Assignment

83.32/100

CMS Quality Rating

703 S AMERICANA BLVD STE 150, BOISE, ID 83702(208) 706-6375 Get Directions Write a Review

NPPES record last updated: March 21, 2023. Verified against the NPPES registry weekly; last sync: August 09, 2026.

Record update history: Mar 21, 2023, Aug 21, 2019, Jul 24, 2018 (3 updates tracked since 2018).

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About Kelly Moore Np NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

KELLY MOORE NP (NPI 1104303072) is an individual psychiatric/mental health provider in Boise, Idaho, licensed in Idaho (59308) and active in the NPI registry since July 2018. She is enrolled in Medicare PECOS, is affiliated with St Luke's Regional Medical Center, and maintains a secondary practice location in Meridian.

NPPES Registry Identity

NPI1104303072

Entity TypeIndividualFemale

Primary Taxonomy363LP0808X

Provider Legal NameKELLY MOORECredential: NP

Location Address703 S AMERICANA BLVD STE 150Boise, ID 83702-4976

Mailing Address190 E Bannock StBoise, ID 83712-6241 · (208) 381-8752

Phone(208) 706-6375

Sole ProprietorYes

Medical School CMSOtherGraduated 2018

Enumeration DateJuly 24, 2018

Last NPPES UpdateMarch 21, 20233 updates tracked since enumeration

NPPES CertifiedMarch 21, 2023

✔ NPI 1104303072 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 2

★ Primary SpecialtyNurse Practitioner · Psychiatric/Mental HealthPhysician Assistants & Advanced Practice Nursing Providers

Taxonomy Code363LP0808X

License✔ Licensed in ID · 59308

Also ListedNurse PractitionerTaxonomy 363L00000X · License 59308 (ID)

703 S AMERICANA BLVD STE 150, Boise, ID 83702

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Secondary Practice Location 1

Location 13280 E Lanark DrMeridian, ID 83642-5982 · Phone (208) 377-4400 · Fax (208) 377-4416

Accepted Insurance

The full list of accepted plans is on the Insurance tab. Issuers include Moda Health Plan, Inc., PacificSource Health Plans, Providence Health Plan.Insurance ›

Medicare Participation & PECOS CMS

Medicare enrollment, assignment, and ordering and referring status from the CMS PECOS system.

Medicare Enrollment Status

✔

Enrolled in Medicare and accepts Medicare assignment

Kelly Moore Np is registered in PECOS and agrees to accept the Medicare-approved amount as full payment. Medicare patients are not billed beyond the standard deductible and coinsurance.

PECOS PAC ID4082966767

PECOS Enrollment IDI20181008001377

Eligible to Order & Refer✔ Part B Labs & Imaging✔ Durable Medical Equipment✔ Home Health Agency✔ Power Mobility DevicesPer the CMS Ordering and Referring file. Eligibility means Medicare pays claims that this provider orders or refers for these categories.

Areas of Expertise CMS Part B claims 3

Services this provider delivered to Medicare fee-for-service patients, from the CMS Medicare utilization data. Higher counts generally reflect more experience with a service; care delivered outside Medicare is not included.

Established patient office or other outpatient visit with moderate level of decision making, if using time, 30 minutes or more 99214

This is a routine check-up for patients who have previously visited our clinic. It involves a comprehensive review of your health and any ongoing treatments. The consultation lasts between 30-39 minutes, allowing enough time to discuss any concerns.

54 services15 patients

Prolonged office or other outpatient evaluation and management service(s) beyond the maximum required time of the primary procedure which has been selected using total time on the date of the primary service; each additional 15 minutes by the physician or G2212

This service refers to extended doctor visits where your healthcare provider spends additional time evaluating and managing your health beyond the primary procedure's required time. This includes each extra 15 minutes spent by the physician on the same day as the primary service.

22 services12 patients

Established patient office or other outpatient visit with high level of medical decision making, if using time, 40 minutes or more 99215

This service involves a follow-up appointment for existing patients, lasting between 40 to 54 minutes. During this time, your healthcare provider will assess your current health status, discuss any changes or concerns, review your treatment plan, and answer any questions you may have.

20 services13 patients

Hospital Affiliations CMS Care Compare

Hospitals where this provider delivers care, identified from recent Medicare claims and place-of-service records.

St Luke's Regional Medical Center

Acute Care Hospitals · Boise, ID

5/5 CMS rating

OwnershipVoluntary non-profit - Private

CMS Certification Number130006

Location190 East Bannock StreetBoise, ID 83712 · Ada County

Emergency services Birthing friendly

Physician Visit Costs CMS claims · ZIP area

Typical Medicare office-visit costs in the 83702 ZIP code area, from fee-for-service claims. These are area statistics, not this provider’s prices; actual charges vary by service and coverage.

New Patient

$81.13 typical visit price

range $52.44 – $160.17

Typical copayment $20.28 (range $13.11 – $40.04)

Most-billed visit code 99203

Established Patient

$93.26 typical visit price

range $16.68 – $130.93

Typical copayment $23.31 (range $4.17 – $32.73)

Most-billed visit code 99214

Amounts reflect what Medicare beneficiaries in this ZIP area are typically charged for office visits. Patients with other coverage should check their individual plans.

Medicare Quality Performance CMS QPP · MIPS

Performance in the CMS Quality Payment Program: the MIPS final score across four weighted categories, and the individual quality measures reported to Medicare.

83.32/100

MIPS Final ScoreMerit-based Incentive Payment System · CMS Quality Payment Program

Scored as part of a group practice

Quality

79.51

Promoting Interoperability

100

Improvement Activities

Cost

64.88

Other Providers at the Same Location NPPES 9

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

MERRILL VELEZ

Psychiatry & Neurology (Psychiatry)