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ANDREA DIANE MOORE FNP-BC
NPI 1710645544
Nurse Practitioner - Family in Jacksonville, IL

Active since November 29, 2021PECOS Enrolled
425 E STATE ST, JACKSONVILLE, IL 62650(217) 408-1195 Get Directions Write a Review

NPPES record last updated: January 9, 2026. Verified against the NPPES registry weekly; last sync: October 18, 2026.

Record update history: Jan 9, 2026, Feb 23, 2022, Nov 29, 2021 (3 updates tracked since 2021).

About Andrea Diane Moore Fnp-bc NPPES

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

ANDREA DIANE MOORE FNP-BC (NPI 1710645544) is an individual family provider in Jacksonville, Illinois, licensed in Illinois (2021039559) and active in the NPI registry since November 2021. She is enrolled in Medicare PECOS and is a graduate of Other (2021).

NPPES Registry Identity

NPI1710645544
Entity TypeIndividualFemale
Primary Taxonomy363LF0000X
Provider Legal NameANDREA DIANE MOORECredential: FNP-BC
Location Address425 E STATE STJacksonville, IL 62650-2125
Mailing Address425 E State StJacksonville, IL 62650-2125
Phone(217) 408-1195
Sole ProprietorYes
Medical School CMSOtherGraduated 2021
Enumeration DateNovember 29, 2021
Last NPPES UpdateJanuary 9, 20263 updates tracked since enumeration
NPPES CertifiedJanuary 9, 2026
✔ NPI 1710645544 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyNurse Practitioner · FamilyPhysician Assistants & Advanced Practice Nursing Providers
Taxonomy Code363LF0000X
License✔ Licensed in IL · 2021039559
425 E STATE ST, Jacksonville, IL 62650
Open in Google Maps ↗

Medicare Participation & PECOS CMS

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

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Andrea Diane Moore Fnp-bc is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

PECOS PAC ID5092270173
PECOS Enrollment IDI20260720001049
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 Reassignment

Medicare enrollment records show Andrea Moore reassigns Medicare billing to 1 organization. The organization bills Medicare for the services this provider delivers there.

Board Of Trustees Of Southern Illinois University
31 mi
Primary Care
520 N 4TH ST
Springfield, IL 62702
  • Reassigned Medicare billing, Illinois enrollment
  • 262 clinicians in this Medicare group
NPI 1396097960 (217) 757-8100

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 62650 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
$85.71 typical visit price
range $54.80 – $168.44
Typical copayment $21.42 (range $13.70 – $42.11)
Most-billed visit code 99203
Established Patient
$97.25 typical visit price
range $17.16 – $136.56
Typical copayment $24.31 (range $4.29 – $34.14)
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 3

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

JADE YOUNG
Community Health Worker
425 E STATE ST
JACKSONVILLE, IL 62650
Morgan County (217) 670-5590
ANNETTE E HUDDLESTON MSW, CADC
Community Health Worker
425 E STATE ST
JACKSONVILLE, IL 62650
Morgan County (217) 408-1195
BETHANY ALLEN
Community Health Worker
425 E STATE ST
JACKSONVILLE, IL 62650
Morgan County (217) 899-1817

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 Andrea Moore's NPI number?

The NPI number for Andrea Moore is 1710645544. It was assigned to this individual provider in the NPPES registry on November 29, 2021.

Where is Andrea Moore located?

Andrea Moore practices at 425 E State St, Jacksonville, IL 62650. The listed phone number is (217) 408-1195.

What is Andrea Moore's specialty?

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

Is Andrea Moore enrolled in Medicare?

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

Which organization bills Medicare for Andrea Moore's services?

According to the CMS Revalidation Reassignment List (October 2026 release), Andrea Moore reassigns Medicare benefits to Board Of Trustees Of Southern Illinois University (Springfield, IL). The 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 Andrea 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 Andrea Moore was last updated on January 9, 2026. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 9 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.