Simone Shardae Williams Moore, MD in Mound Bayou, MS - Medicare Student in an Organized Health Care Education/Training Program

Simone Shardae Williams Moore, MD is a medicare enrolled "Student In An Organized Health Care Education/training Program" physician in Mound Bayou, Mississippi. Her current practice location is 702 Martin Luther King St, Mound Bayou, Mississippi. You can reach out to her office (for appointments etc.) via phone at (662) 741-8800.

Simone Shardae Williams Moore is licensed to practice in * (Not Available) (license number ) and she also participates in the medicare program. She does not accept medicare assignments directly but she may accept medicare through third-party (refer to Reassignment section below) and may also prescribe medicare part D drugs. Her NPI Number is 1730602806.

Contact Information

	Simone Shardae Williams Moore, MD
	702 Martin Luther King St, Mound Bayou, MS 38762-9314
	(662) 741-8800
	(662) 741-2700

Map and Direction

Physician's Profile

Full Name	Simone Shardae Williams Moore
Gender	Female
Speciality	Student In An Organized Health Care Education/training Program
Location	702 Martin Luther King St, Mound Bayou, Mississippi
Accepts Medicare Assignments	Medicare enrolled and may accept medicare through third-party reassignment. May prescribe medicare part D drugs.

NPI Data:

NPI Number: 1730602806
Provider Enumeration Date: 07/20/2017
Last Update Date: 08/05/2020

Medicare PECOS Information:

PECOS PAC ID: 1052684479
Enrollment ID: I20230215003082

Medical Identifiers

Medical identifiers for Simone Shardae Williams Moore such as npi, medicare ID, medicare PIN, medicaid, etc.

Identifier	Type	State	Issuer
1730602806	NPI	-	NPPES
04501349	Medicaid	MS

Medical Taxonomies and Licenses

Taxonomy	Type	License (State)	Status
208000000X	Pediatrics	27978 (Mississippi)	Secondary
390200000X	Student In An Organized Health Care Education/training Program	(* (Not Available))	Primary

Medicare Reassignments

Some practitioners may not bill the customers directly but medicare billing happens through clinics / group practice / hospitals where the provider works. Medicare reassignment of benefits is a mechanism by which practitioners allow third parties to bill and receive payment for medicare services performed by them. Simone Shardae Williams Moore allows following entities to bill medicare on her behalf.

Entity Name	Delta Health Center, Inc.
Entity Type	Part B Supplier - Clinic/group Practice
Entity Identifiers	NPI Number: 1659378610 PECOS PAC ID: 6608783295 Enrollment ID: O20040216000676

Medicare Part D Prescriber Enrollment

Any physician or other eligible professional who prescribes Part D drugs must either enroll in the Medicare program or opt out in order to prescribe drugs to their patients with Part D prescription drug benefit plans. Simone Shardae Williams Moore is enrolled with medicare and thus, if eligible, can prescribe medicare part D drugs to patients with medicare part D benefits.

Mailing Address and Practice Location

Mailing Address	Practice Location Address
Simone Shardae Williams Moore, MD 2500 N State St, Jackson, MS 39216-4500 Ph: () -	Simone Shardae Williams Moore, MD 702 Martin Luther King St, Mound Bayou, MS 38762-9314 Ph: (662) 741-8800

Simone Shardae Williams Moore, MD - Medicare Student in an Organized Health Care Education/Training Program in Mound Bayou, MS