JUSTIN RICHARDSON MOORE MD
NPI 1104679059
Student in an Organized Health Care Education/Training Program in Chicago, IL
About Justin Richardson Moore Md NPPES
Official registry information on file with the National Plan and Provider Enumeration System.
JUSTIN RICHARDSON MOORE MD (NPI 1104679059) is an individual student in an organized health care education/training program in Chicago, Illinois and active in the NPI registry since April 2024. He is enrolled in Medicare PECOS.
NPPES Registry Identity
Specialties & Licenses 2
Medicare Participation & PECOS CMS
Medicare enrollment, assignment, and ordering and referring status from the CMS PECOS system.
Medicare Enrollment Status
Enrolled in Medicare (PECOS)
Justin Richardson Moore Md is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).
Other Providers at the Same Location NPPES 20
Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.
CHICAG, IL 60612
CHICAGO, IL 60612
Frequently Asked Questions NPPES & CMS
Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.
What is Justin Moore's NPI number?
The NPI number for Justin Moore is 1104679059. It was assigned to this individual provider in the NPPES registry on April 10, 2024.
Where is Justin Moore located?
Justin Moore practices at 1901 W Harrison St, Chicago, IL 60612. The listed phone number is (312) 864-6000.
What is Justin Moore's specialty?
The primary specialty registered for this NPI is Student in an Organized Health Care Education/Training Program with taxonomy code 390200000X.
Is Justin Moore enrolled in Medicare?
Yes. Justin Moore is registered in the Medicare PECOS enrollment system.
When was this NPI record last updated?
The NPPES record for Justin Moore was last updated on May 11, 2025. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 15 months 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.
# Justin Richardson Moore, MD · NPI 1104679059
Student in an Organized Health Care Education/Training Program provider in Chicago, Illinois. Individual provider, active in the CMS NPPES registry since April 10, 2024.
## Identity
- **NPI:** 1104679059 (Entity type: Individual)
- **Enumerated:** April 10, 2024
- **Primary specialty:** Student in an Organized Health Care Education/Training Program · taxonomy 390200000X
- **Sole proprietor:** No
## Practice location
- **Address:** 1901 W HARRISON ST, Chicago, IL 60612-3714
- **Phone:** (312) 864-6000
## Medicare
- **Medicare:** Enrolled in Medicare (PECOS)
- **Ordering & referring:** eligible for Part B labs & imaging, durable medical equipment, home health, power mobility devices
## Record status
- **NPPES last updated:** May 11, 2025
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Source: [NPI Profile](https://npiprofile.com/npi/1104679059) · Data from the CMS NPPES public registry.