THEODORE LYDELL MOORE
NPI 1386348878
Student in an Organized Health Care Education/Training Program in Chicago, IL

Q: What is Theodore Moore's NPI number?

The NPI number for Theodore Moore is 1386348878. It was assigned to this individual provider in the NPPES registry on March 28, 2023.

Q: What is Theodore Moore's specialty?

The primary specialty registered for this NPI is Student in an Organized Health Care Education/Training Program with taxonomy code 390200000X.

Q: When was this NPI record last updated?

The NPPES record for Theodore Moore was last updated on June 26, 2026. NPI Profile syncs with the weekly NPPES data releases published by CMS.

Active since March 28, 2023PECOS Enrolled

5841 S. MARYLAND AVE., M/C 4076, CHICAGO, IL 60637(773) 795-1824 Get Directions Write a Review

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

Record update history: May 3, 2023, Mar 28, 2023 (2 updates tracked since 2023).

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About Theodore Lydell Moore NPPES

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

THEODORE LYDELL MOORE (NPI 1386348878) is an individual student in an organized health care education/training program in Chicago, Illinois and active in the NPI registry since March 2023. He is enrolled in Medicare PECOS.

NPPES Registry Identity

NPI1386348878

Entity TypeIndividualMale

Primary Taxonomy390200000X

Provider Legal NameTHEODORE LYDELL MOORE

Location Address5841 S. MARYLAND AVE., M/C 4076Chicago, IL 60637-1443

Mailing Address180 Harvester Dr Ste 110Burr Ridge, IL 60527-6686 · (773) 702-1150

Phone(773) 795-1824

Sole ProprietorNo

Enumeration DateMarch 28, 2023

Last NPPES UpdateJune 26, 20262 updates tracked since enumeration

NPPES CertifiedJune 26, 2026

✔ NPI 1386348878 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyStudent in an Organized Health Care Education/Training ProgramStudent, Health Care

Taxonomy Code390200000X

Definition

An individual who is enrolled in an organized health care education/training program leading to a degree, certification, registration, and/or licensure to provide health care.

5841 S. MARYLAND AVE., Chicago, IL 60637

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Medicare Participation & PECOS CMS

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

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

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

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.