JERRY R MOORE LPC, LICDC
NPI 1558845743
Counselor - Professional in Marysville, OH

Q: What is Jerry Moore's NPI number?

The NPI number for Jerry Moore is 1558845743. It was assigned to this individual provider in the NPPES registry on September 24, 2018.

Q: What is Jerry Moore's specialty?

The primary specialty registered for this NPI is Counselor, specializing in Professional, with taxonomy code 101YP2500X.

Q: When was this NPI record last updated?

The NPPES record for Jerry Moore was last updated on April 8, 2026. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 4 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.

Active since September 24, 2018PECOS Enrolled

16000 HUNTERS RUN, MARYSVILLE, OH 43040(614) 582-1081 Get Directions Write a Review

NPPES record last updated: April 8, 2026. Verified against the NPPES registry weekly; last sync: August 16, 2026.

Record update history: Apr 8, 2026, Sep 24, 2018 (2 updates tracked since 2018).

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About Jerry R Moore Lpc, Licdc NPPES

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

JERRY R MOORE LPC, LICDC (NPI 1558845743) is an individual professional provider in Marysville, Ohio, licensed in Ohio (E.1901574-SUPV) and active in the NPI registry since September 2018. He is enrolled in Medicare PECOS and is a graduate of Other (2014).

NPPES Registry Identity

NPI1558845743

Entity TypeIndividualMale

Primary Taxonomy101YP2500X

Provider Legal NameJERRY R MOORECredential: LPC, LICDC

Location Address16000 HUNTERS RUNMarysville, OH 43040-9659

Mailing Address16000 Hunters RunMarysville, OH 43040-9659 · (614) 582-1081

Phone(614) 582-1081

Sole ProprietorYes

Medical School CMSOtherGraduated 2014

Enumeration DateSeptember 24, 2018

Last NPPES UpdateApril 8, 20262 updates tracked since enumeration

NPPES CertifiedApril 8, 2026

✔ NPI 1558845743 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyCounselor · ProfessionalBehavioral Health & Social Service Providers

Taxonomy Code101YP2500X

License✔ Licensed in OH · E.1901574-SUPV

16000 HUNTERS RUN, Marysville, OH 43040

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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)

Jerry R Moore Lpc, Licdc is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

PECOS PAC ID8224506225

PECOS Enrollment IDI20260507003461

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.

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 Jerry Moore's NPI number?

The NPI number for Jerry Moore is 1558845743. It was assigned to this individual provider in the NPPES registry on September 24, 2018.

Where is Jerry Moore located?

Jerry Moore practices at 16000 Hunters Run, Marysville, OH 43040. The listed phone number is (614) 582-1081.

What is Jerry Moore's specialty?

The primary specialty registered for this NPI is Counselor, specializing in Professional, with taxonomy code 101YP2500X.

Is Jerry Moore enrolled in Medicare?

Yes. Jerry Moore is registered in the Medicare PECOS enrollment system.

When was this NPI record last updated?

The NPPES record for Jerry Moore was last updated on April 8, 2026. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 4 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.