ETHAN THOMAS MOORE MD
NPI 1619810926
Otolaryngology - Plastic Surgery within the Head & Neck in Rochester, MN

Q: What is Ethan Moore's NPI number?

The NPI number for Ethan Moore is 1619810926. It was assigned to this individual provider in the NPPES registry on April 11, 2026.

Q: What is Ethan Moore's specialty?

The primary specialty registered for this NPI is Otolaryngology, specializing in Plastic Surgery within the Head & Neck, with taxonomy code 207YX0007X.

Q: When was this NPI record last updated?

The NPPES record for Ethan Moore was last updated on April 27, 2026. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 3 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 April 11, 2026PECOS Enrolled

200 1ST ST SW, ROCHESTER, MN 55905(507) 284-2511 Get Directions Write a Review

NPPES record last updated: April 27, 2026. Verified against the NPPES registry weekly; last sync: August 16, 2026.

Record update history: Apr 27, 2026, Apr 11, 2026 (2 updates tracked since 2026).

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About Ethan Thomas Moore Md NPPES

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

ETHAN THOMAS MOORE MD (NPI 1619810926) is an individual plastic surgery within the head & neck provider in Rochester, Minnesota, licensed in Minnesota (36291) and active in the NPI registry since April 2026. He is enrolled in Medicare PECOS.

NPPES Registry Identity

NPI1619810926

Entity TypeIndividualMale

Primary Taxonomy207YX0007X

Provider Legal NameETHAN THOMAS MOORECredential: MD

Location Address200 1ST ST SWRochester, MN 55905-0002

Mailing AddressPo Box 860912Minneapolis, MN 55486-0912 · (507) 284-2511 · Fax (507) 284-0702

Phone(507) 284-2511

Sole ProprietorNo

Enumeration DateApril 11, 2026

Last NPPES UpdateApril 27, 20262 updates tracked since enumeration

NPPES CertifiedApril 27, 2026

✔ NPI 1619810926 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyOtolaryngology · Plastic Surgery within the Head & NeckAllopathic & Osteopathic Physicians

Taxonomy Code207YX0007X

License✔ Licensed in MN · 36291

Definition

An otolaryngologist with additional training in plastic and reconstructive procedures within the head, face, neck and associated structures, including cutaneous head and neck oncology and reconstruction, management of maxillofacial trauma, soft tissue repair and neural surgery. The field is diverse and involves a wide age range of patients, from the newborn to the aged. While both cosmetic and reconstructive surgeries are practiced, there are many additional procedures which interface with them.

200 1ST ST SW, Rochester, MN 55905

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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)

Ethan Thomas Moore Md 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.

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.

EMILY LEASURE MD

Internal Medicine