Recently Updated NPI Information — some details in this NPI profile have been updated in the NPI registry within the last 60 days.

NYDRA MOORE LCSW
NPI 1174259287
Social Worker - Clinical in Grand Rapids, MI

Q: What is Nydra Moore's NPI number?

The NPI number for Nydra Moore is 1174259287. It was assigned to this individual provider in the NPPES registry on July 29, 2022.

Q: What is Nydra Moore's specialty?

The primary specialty registered for this NPI is Social Worker, specializing in Clinical, with taxonomy code 1041C0700X.

Q: When was this NPI record last updated?

The NPPES record for Nydra Moore was last updated on June 26, 2026. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 50 days 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 29, 2022PECOS Enrolled

790 FULLER AVE NE, GRAND RAPIDS, MI 49503(616) 336-3909(616) 336-8830 Get Directions Write a Review

NPPES record last updated: June 26, 2026. Verified against the NPPES registry weekly; last sync: August 09, 2026.

Record update history: Nov 7, 2025, Nov 28, 2022, Jul 29, 2022 (3 updates tracked since 2022).

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About Nydra Moore Lcsw NPPES

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

NYDRA MOORE LCSW (NPI 1174259287) is an individual clinical provider in Grand Rapids, Michigan, licensed in Michigan (6801120788) and active in the NPI registry since July 2022. She is enrolled in Medicare PECOS, maintains a secondary practice location in Grand Rapids, and is a graduate of Other (2022).

NPPES Registry Identity

NPI1174259287

Entity TypeIndividualFemale

Primary Taxonomy1041C0700X

Provider Legal NameNYDRA MOORECredential: LCSW

Location Address790 FULLER AVE NEGrand Rapids, MI 49503-1918

Mailing Address790 Fuller Ave NeGrand Rapids, MI 49503-1918 · (616) 336-3909 · Fax (616) 336-8830

Phone(616) 336-3909

Fax(616) 336-8830

Sole ProprietorNo

Medical School CMSOtherGraduated 2022

Enumeration DateJuly 29, 2022

Last NPPES UpdateJune 26, 20263 updates tracked since enumeration

NPPES CertifiedJune 26, 2026

✔ NPI 1174259287 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtySocial Worker · ClinicalBehavioral Health & Social Service Providers

Taxonomy Code1041C0700X

License✔ Licensed in MI · 6801120788

Definition

A social worker who holds a master's or doctoral degree in social work from an accredited school of social work in addition to at least two years of post-master's supervised experience in a clinical setting. The social worker must be licensed, certified, or registered at the clinical level in the jurisdiction of practice. A clinical social worker provides direct services, including interventions focused on interpersonal interactions, intrapsychic dynamics, and life management issues. Clinical social work services are based on bio-psychosocial perspectives. Services consist of assessment, diagnosis, treatment (including psychotherapy and counseling), client-centered advocacy, consultation, evaluation, and prevention of mental illness, emotional, or behavioral disturbances.

790 FULLER AVE NE, Grand Rapids, MI 49503

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Secondary Practice Location 1

Location 1620 Century Ave SW Ste 120Grand Rapids, MI 49503-4977 · Phone (616) 329-9857

Medicare Participation & PECOS CMS

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

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Nydra Moore Lcsw is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

PECOS PAC ID6002307840

PECOS Enrollment IDI20251119001421

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.

Physician Visit Costs CMS claims · ZIP area

Typical Medicare office-visit costs in the 49503 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

$0.00 typical visit price

range $54.34 – $166.68

Typical copayment $0.00 (range $13.58 – $41.67)

Most-billed visit code NA

Established Patient

$68.07 typical visit price

range $17.09 – $135.40

Typical copayment $17.01 (range $4.27 – $33.85)

Most-billed visit code 99213

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

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.

DIANA DUARTE-MENENDEZ LMSW

Social Worker (Clinical)