Traci Moore, APRN, FNP-C is a medicare enrolled "Family Medicine" in Kingman, Arizona. Her current practice location is
3931 N Stockton Hill Rd, Kingman, Arizona. You can reach out to her office (for appointments etc.) via phone at
(928) 377-0935.
Traci Moore is licensed to practice in Arizona (license number RNP315038) 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 1225570005.
Provider's Profile
Full Name | Traci Moore |
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Gender | Female |
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Speciality | Family Medicine |
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Location | 3931 N Stockton Hill Rd, Kingman, Arizona |
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Accepts Medicare Assignments | Medicare enrolled and may accept medicare through third-party reassignment. May prescribe medicare part D drugs. |
NPI Data:
- NPI Number: 1225570005
- Provider Enumeration Date: 11/10/2016
- Last Update Date: 11/12/2024
Medicare PECOS Information:
- PECOS PAC ID: 3476085457
- Enrollment ID: I20241015003254
Medical Identifiers
Medical identifiers for Traci Moore such as npi, medicare ID, medicare PIN, medicaid, etc.
Identifier | Type | State | Issuer |
1225570005 | NPI | - | NPPES |
Medical Taxonomies and Licenses
Taxonomy | Type | License (State) | Status |
163W00000X | Registered Nurse | RN186954 (Arizona) | Secondary |
163WP0808X | Registered Nurse - Psychiatric/mental Health | RN186954 (Arizona) | Secondary |
207Q00000X | Family Medicine | RNP315038 (Arizona) | 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. Traci Moore allows following entities to bill medicare on her behalf.
Entity Name | Lakeside Heart And Vascular Center Pllc |
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Entity Type | Part B Supplier - Clinic/group Practice |
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Entity Identifiers | NPI Number: 1801194352 PECOS PAC ID: 4587832779 Enrollment ID: O20110713000658 |
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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. Traci 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 |
Traci Moore, APRN, FNP-C 3931 N Stockton Hill Rd, Kingman, AZ 86409-2426 Ph: (928) 377-0935 | Traci Moore, APRN, FNP-C 3931 N Stockton Hill Rd, Kingman, AZ 86409-2426 Ph: (928) 377-0935 |
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