Physician Compare National (NPI:1497800403)

HEALTHCARE PROVIDER: FREDERICK DM MOORE MD

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

Individual Professional Information
NPI	1497800403
	Unique healthcare provider (clinician) ID assigned by NPPES
PECOS UID	5092140129
	Unique individual clinician ID assigned by PECOS
Professional Enrollment ID	I20200121000079
	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	FREDERICK
	Individual professional first name
Provider Middle Name	DM
	Individual professional middle name
Provider Gender	M
	The provider's gender if the provider is a person.

Medical School Information
Medical School Name	DUKE UNIVERSITY SCHOOL OF MEDICINE
	Individual professional's medical school
Graduation Year	2000
	Individual professional's medical school graduation year
Primary Specialty	ORTHOPEDIC SURGERY
	Primary medical specialty reported by the individual professional in the selected enrollment

Practice Information
Organization Legal Name	SOUTHEAST ORTHOPEDIC SPECIALISTS 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	1456246974
	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	59
	Total number of individual professionals affiliated with the Group Practice based on Group Practice PAC ID
Line 1 Street Address	15255 MAX LEGGETT PKWY
	Group Practice or individual's line 1 address
Line 2 Street Address	SUITE 5300
	Group Practice or individual's line 2 address
City	JACKSONVILLE
	Group Practice or individual's city
State	FL
	Group Practice or individual's state
Zip Code	322187274
	Group Practice or individual's zip code (9 digits when available)
Phone Number	90463406401014
	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	100040
	Medicare CCN of hospital where individual professional provides service 1
Hospital Affiliation LBN 1	ST VINCENT'S MEDICAL CENTER RIVERSIDE
	Legal business name of hospital where individual professional provides service 1
Professional Accepts Medicare Assignment	Y