SHANNON VICTORIA MOORE PHD
NPI 1639881253
Psychologist - Clinical in Vacaville, CA
About Shannon Victoria Moore Phd NPPES
Official registry information on file with the National Plan and Provider Enumeration System.
SHANNON VICTORIA MOORE PHD (NPI 1639881253) is an individual clinical provider in Vacaville, California, licensed in California (33838) and active in the NPI registry since December 2022. She is enrolled in Medicare PECOS.
NPPES Registry Identity
Specialties & Licenses
Medicare Participation & PECOS CMS
Medicare enrollment, assignment, billing reassignment, and ordering and referring status from CMS.
Medicare Enrollment Status
Enrolled in Medicare (PECOS)
Shannon Victoria Moore Phd is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).
Medicare Billing Reassignments
2Medicare enrollment records show Shannon Moore reassigns Medicare billing to 2 organizations. Each organization bills Medicare for the services this provider delivers there; the nearest is listed first.
Santa Clara, CA 95054
- Reassigned Medicare billing, California enrollment
- 1,607 clinicians in this Medicare group
Carlsbad, CA 92008
- Reassigned Medicare billing, California enrollment
- 223 clinicians in this Medicare group
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 95688 ZIP code area, from fee-for-service claims. These are area statistics, not this provider’s prices; actual charges vary by service and coverage.
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.
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 Shannon Moore's NPI number?
The NPI number for Shannon Moore is 1639881253. It was assigned to this individual provider in the NPPES registry on December 14, 2022.
Where is Shannon Moore located?
Shannon Moore practices at 1 Quality Dr, Vacaville, CA 95688. The listed phone number is (707) 624-2830.
What is Shannon Moore's specialty?
The primary specialty registered for this NPI is Psychologist, specializing in Clinical, with taxonomy code 103TC0700X.
Is Shannon Moore enrolled in Medicare?
Yes. Shannon Moore is registered in the Medicare PECOS enrollment system.
Which organizations bill Medicare for Shannon Moore's services?
According to the CMS Revalidation Reassignment List (October 2026 release), Shannon Moore reassigns Medicare benefits to 2 organizations: Sud Specialty Group - Ca (Santa Clara, CA) and Memory Check Psychological Services, A Professional Corporation (Carlsbad, CA). 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 Shannon Moore's services. Reassignment records can lag staffing changes; confirm current arrangements with the organization.
When was this NPI record last updated?
The NPPES record for Shannon Moore was last updated on December 14, 2022. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 3 years 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.
# Shannon Victoria Moore, PHD · NPI 1639881253
Clinical provider in Vacaville, California. Individual provider, active in the CMS NPPES registry since December 14, 2022.
## Identity
- **NPI:** 1639881253 (Entity type: Individual)
- **Enumerated:** December 14, 2022
- **Primary specialty:** Psychologist - Clinical · taxonomy 103TC0700X
- **State license:** 33838 (California)
- **Sole proprietor:** Yes
## Practice location
- **Address:** 1 QUALITY DR, Vacaville, CA 95688-9494
- **Phone:** (707) 624-2830
## Medicare
- **Medicare:** Enrolled in Medicare (PECOS)
- **Ordering & referring:** eligible for durable medical equipment
- **Bills Medicare through:** 2 organizations under Medicare reassignment (form CMS-855R): Sud Specialty Group - Ca (NPI 1972138238, Santa Clara, CA); Memory Check Psychological Services, A Professional Corporation (NPI 1912184219, Carlsbad, CA) · CMS Revalidation Reassignment List, October 2026 release
## Record status
- **NPPES last updated:** December 14, 2022
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Source: [NPI Profile](https://npiprofile.com/npi/1639881253) · Data from the CMS NPPES public registry.