Kelly Moore, NP - Medicare Nurse Practitioner in Boise, ID

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Kelly Moore, NP is a medicare enrolled "Nurse Practitioner - Psychiatric/mental Health" in Boise, Idaho. Her current practice location is 703 S Americana Blvd Ste 150, Boise, Idaho. You can reach out to her office (for appointments etc.) via phone at (208) 706-6375.

Kelly Moore is licensed to practice in Idaho (license number 59308) 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 1104303072.

Contact Information

Kelly Moore, NP
703 S Americana Blvd Ste 150,
Boise, ID 83702-4976
(208) 706-6375
Not Available

Map and Direction




Provider's Profile

Full NameKelly Moore
GenderFemale
SpecialityNurse Practitioner - Psychiatric/mental Health
Location703 S Americana Blvd Ste 150, Boise, Idaho
Accepts Medicare AssignmentsMedicare enrolled and may accept medicare through third-party reassignment. May prescribe medicare part D drugs.
  NPI Data:
  • NPI Number: 1104303072
  • Provider Enumeration Date: 07/24/2018
  • Last Update Date: 03/21/2023
  Medicare PECOS Information:
  • PECOS PAC ID: 4082966767
  • Enrollment ID: I20181008001377

Medical Identifiers

Medical identifiers for Kelly Moore such as npi, medicare ID, medicare PIN, medicaid, etc.
IdentifierTypeStateIssuer
1104303072NPI-NPPES

Medical Taxonomies and Licenses

TaxonomyTypeLicense (State)Status
363L00000XNurse Practitioner 59308 (Idaho)Secondary
363LP0808XNurse Practitioner - Psychiatric/mental Health 59308 (Idaho)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. Kelly Moore allows following entities to bill medicare on her behalf.
Entity NameAlliance Medical Group Llc
Entity TypePart B Supplier - Clinic/group Practice
Entity IdentifiersNPI Number: 1568413920
PECOS PAC ID: 3971544685
Enrollment ID: O20050512000561
Entity NameSt Lukes Clinic-treasure Valley Llc
Entity TypePart B Supplier - Clinic/group Practice
Entity IdentifiersNPI Number: 1326336058
PECOS PAC ID: 4981878402
Enrollment ID: O20111119000045

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. Kelly 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 AddressPractice Location Address
Kelly Moore, NP
190 E Bannock St,
Boise, ID 83712-6241

Ph: (208) 381-8752		Kelly Moore, NP
703 S Americana Blvd Ste 150,
Boise, ID 83702-4976

Ph: (208) 706-6375

Reviews and Comments


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Medicare Program: Medicare is a federal government program which provides health insurance to people who are 65 or older. This program also covers certain younger people with disabilities (who receive Social Security Disability Insurance - SSDI), and people with End-Stage Renal Disease (permanent kidney failure requiring dialysis or a transplant, sometimes called ESRD.

Medicare Assignment: Assignment means that your doctor, provider, or supplier agrees (or is required by law) to accept the Medicare-approved amount as full payment for covered services. Most doctors, providers, and suppliers accept assignment, but you should always check to make sure. Participating providers have signed an agreement to accept assignment for all Medicare-covered services.

NPI Number: The National Provider Identifier (NPI) is a unique identification number for covered health care providers. The NPI must be used in lieu of legacy provider identifiers in the HIPAA standards transactions. Covered health care providers and all health plans and health care clearinghouses must use the NPIs in the administrative and financial transactions adopted under HIPAA (Health Insurance Portability and Accountability Act).

Our Data: Information on www.medicarelist.com is built using data sources published by Centers for Medicare & Medicaid Services (CMS) under Freedom of Information Act (FOIA). The information disclosed on the NPI Registry are FOIA-disclosable and are required to be disclosed under the FOIA and the eFOIA amendments to the FOIA. There is no way to 'opt out' or 'suppress' the NPPES record data for health care providers with active NPIs.