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MS. MARY SUE MOORE PMHNP
NPI 1508221284
Nurse Practitioner - Family in Port St Joe, FL

Active since December 22, 2015PECOS EnrolledAccepts Medicare Assignment
401 CECIL G COSTIN SR BLVD, PORT ST JOE, FL 32456(850) 229-1043 Get Directions Write a Review

NPPES record last updated: May 19, 2026. Verified against the NPPES registry weekly; last sync: October 18, 2026.

Record update history: May 19, 2026, Feb 3, 2026, May 1, 2023 and 2 more (5 updates tracked since 2015).

About Ms. Mary Sue Moore Pmhnp NPPES

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

MS. MARY SUE MOORE PMHNP (NPI 1508221284) is an individual family provider in Port St Joe, Florida, licensed in Florida (APRN9162481) and active in the NPI registry since December 2015. She is enrolled in Medicare PECOS, maintains a secondary practice location in Blountstown, and is a graduate of Other (2018).

NPPES Registry Identity

NPI1508221284
Entity TypeIndividualFemale
Primary Taxonomy363LF0000X
Provider Legal NameMS. MARY SUE MOORECredential: PMHNP
Location Address401 CECIL G COSTIN SR BLVDPort St Joe, FL 32456-1928
Mailing Address11523 Sw Mcclellan Farm RdClarksville, FL 32430-3043 · (850) 899-3191
Phone(850) 229-1043
Sole ProprietorYes
Medical School CMSOtherGraduated 2018
Enumeration DateDecember 22, 2015
Last NPPES UpdateMay 19, 20265 updates tracked since enumeration
NPPES CertifiedMay 19, 2026
✔ NPI 1508221284 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 3

★ Primary SpecialtyNurse Practitioner · FamilyPhysician Assistants & Advanced Practice Nursing Providers
Taxonomy Code363LF0000X
License✔ Licensed in FL · APRN9162481
Also ListedRegistered NurseTaxonomy 163W00000X · License RN9162481 (FL)
Also ListedNurse Practitioner · Psychiatric/Mental HealthTaxonomy 363LP0808X · License APRN9162481 (FL)
401 CECIL G COSTIN SR BLVD, Port St Joe, FL 32456
Open in Google Maps ↗

Secondary Practice Location 1

Location 120370 NE Burns AveBlountstown, FL 32424-1045 · Phone (850) 674-5411 ext. 214

Accepted Insurance

The full list of accepted plans is on the Insurance tab. Issuers include Ambetter from Superior HealthPlan, Ambetter Health, Ambetter of Alabama and more.Insurance ›

Medicare Participation & PECOS CMS

Medicare enrollment, assignment, billing reassignment, and ordering and referring status from CMS.

Medicare Enrollment Status

✔

Enrolled in Medicare and accepts Medicare assignment

Ms. Mary Sue Moore Pmhnp 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 ID143565952
PECOS Enrollment IDI20181226001491
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.

Medicare Billing Reassignments

3

Medicare enrollment records show Mary Moore reassigns Medicare billing to 3 organizations. Each organization bills Medicare for the services this provider delivers there; the nearest is listed first.

Pancare Of Florida, Inc
3.6 mi
Federally Qualified Health Center (FQHC)
2235 E 15TH ST
Panama City, FL 32405
  • Reassigned Medicare billing, Florida enrollment
  • 51 clinicians in this Medicare group
NPI 1366456287 (850) 747-5272
Calhoun-Liberty Hospital Association Inc
39 mi
Emergency Care
16257 STATE ROAD 71 S
Blountstown, FL 32424
  • Reassigned Medicare billing, Florida enrollment
  • 24 clinicians in this Medicare group
NPI 1649596784 (850) 674-5411
Small Hospital Innovations LLC
367 mi
Emergency Medicine
524 W SAGAMORE AVE
Clewiston, FL 33440
  • Reassigned Medicare billing, Florida enrollment
  • 147 clinicians in this Medicare group
NPI 1184040560 (305) 204-9318

Source: CMS Revalidation Reassignment List, October 2026 release. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.

Physician Visit Costs CMS claims · ZIP area

Typical Medicare office-visit costs in the 32456 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
$87.62 typical visit price
range $56.00 – $171.84
Typical copayment $21.90 (range $14.00 – $42.96)
Most-billed visit code 99203
Established Patient
$99.16 typical visit price
range $17.57 – $139.16
Typical copayment $24.79 (range $4.39 – $34.79)
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.

Other Providers at the Same Location NPPES 6

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

MISS JANEL DENISE ZIMMERMAN LMSW
Social Worker (Clinical)
401 CECIL G COSTIN SR BLVD
PORT ST JOE, FL 32456
Gulf County (850) 229-1043
DR. ERIC HAYNAM D.D.S
Dentist (General Practice)
401 CECIL G COSTIN SR BLVD
PORT ST JOE, FL 32456
Gulf County (850) 229-1043
PANCARE OF FLORIDA, INC
Pharmacy (Community/Retail Pharmacy)
401 CECIL G COSTIN SR BLVD
PORT ST JOE, FL 32456
Gulf County (850) 229-1043
PANCARE OF FLORIDA, INC
Clinic/Center (Federally Qualified Health Center (FQHC))
401 CECIL G COSTIN SR BLVD
PORT ST JOE, FL 32456
Gulf County (850) 229-1043
DR. EFREN CARBONELL M.D.
General Practice
401 CECIL G COSTIN SR BLVD
PORT ST JOE, FL 32456
Gulf County (850) 229-1043
PANCARE OF FLORIDA, INC
Clinic/Center (Federally Qualified Health Center (FQHC))
401 CECIL G COSTIN SR BLVD
PORT ST JOE, FL 32456
Gulf County (850) 229-1043

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 Mary Moore's NPI number?

The NPI number for Mary Moore is 1508221284. It was assigned to this individual provider in the NPPES registry on December 22, 2015.

Where is Mary Moore located?

Mary Moore practices at 401 Cecil G Costin Sr Blvd, Port St Joe, FL 32456. The listed phone number is (850) 229-1043.

What is Mary Moore's specialty?

The primary specialty registered for this NPI is Nurse Practitioner, specializing in Family, with taxonomy code 363LF0000X.

Is Mary Moore enrolled in Medicare?

Yes. Mary Moore is registered in the Medicare PECOS system and accepts Medicare assignment, which means accepting the Medicare-approved amount as payment in full for covered services.

Which organizations bill Medicare for Mary Moore's services?

According to the CMS Revalidation Reassignment List (October 2026 release), Mary Moore reassigns Medicare benefits to 3 organizations: Pancare Of Florida, Inc (Panama City, FL), Calhoun-Liberty Hospital Association Inc (Blountstown, FL) and Small Hospital Innovations LLC (Clewiston, FL). Each reassignment is filed with Medicare on form CMS-855R, signed by both the clinician and the organization, and lets the organization bill Medicare and receive payment for Mary Moore's services. Reassignment records can lag staffing changes; confirm current arrangements with the organization.

What insurance does Mary Moore accept?

Health plans from Ambetter Health, Ambetter from Superior HealthPlan, Ambetter of Alabama, Cigna HealthCare of Florida, Inc. and Cigna Healthcare and 3 other insurers list Mary Moore as in-network in at least one marketplace plan. Coverage varies by plan and year; verify with the insurer or the provider before a visit.

When was this NPI record last updated?

The NPPES record for Mary Moore was last updated on May 19, 2026. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 5 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.