Physician Compare National (NPI:1194102129)

HEALTHCARE PROVIDER: JOSHUA MOORE

Physician Compare National contains general information about individual eligible professionals (EPs) such as demographic information and Medicare quality program participation.

Individual Professional Information
NPI	1194102129
	Unique healthcare provider (clinician) ID assigned by NPPES
PECOS UID	1052608569
	Unique individual clinician ID assigned by PECOS
Professional Enrollment ID	I20170921003604
	Unique ID for the individual professional enrollment that is the source for the data in the observation
Provider Last Name	MOORE
	Individual professional last name
Provider First Name	JOSHUA
	Individual professional first name
Provider Middle Name	R
	Individual professional middle name
Provider Gender	M
	The provider's gender if the provider is a person.

Medical School Information
Medical School Name	UNIVERSITY OF LOUISVILLE SCHOOL OF MEDICINE
	Individual professional's medical school
Graduation Year	2015
	Individual professional's medical school graduation year
Primary Specialty	PSYCHIATRY
	Primary medical specialty reported by the individual professional in the selected enrollment

Practice Information
Organization Legal Name	LAKE CUMBERLAND REGIONAL MENTAL HEALTH MENTAL RETARDATION BOARD INC .
	Legal name of the Group Practice that the individual professional works with- will be blank if the address is not linked to a Group Practice
Group Practice PAC ID	3375536717
	Unique Group Practice ID assigned by PECOS to the Group Practice that the individual professional works with- will be blank if the address is not linked to a Group Practice
Number of Group Practice members	16
	Total number of individual professionals affiliated with the Group Practice based on Group Practice PAC ID
Line 1 Street Address	130 SOUTHERN SCHOOL RD
	Group Practice or individual's line 1 address
City	SOMERSET
	Group Practice or individual's city
State	KY
	Group Practice or individual's state
Zip Code	425013223
	Group Practice or individual's zip code (9 digits when available)
Phone Number	6066794782
	Phone number is listed only when there is a single phone number available for the practice location address

Hospital(s) Affiliation Information
Hospital Affiliation CCN 1	180088
	Medicare CCN of hospital where individual professional provides service 1
Hospital Affiliation LBN 1	NORTON HOSPITALS, INC
	Legal business name of hospital where individual professional provides service 1
Hospital Affiliation CCN 2	180141
	Medicare CCN of hospital where individual professional provides service 2
Hospital Affiliation LBN 2	UNIVERSITY OF LOUISVILLE HOSPITAL
	Legal business name of hospital where individual professional provides service 2
Professional Accepts Medicare Assignment	Y