Mr Samuel C Moore, PMHNP FNP-C is a medicare enrolled "Nurse Practitioner - Family" physician in Hartsville, Tennessee. His current practice location is
140 Macon Way, Hartsville, Tennessee. You can reach out to his office (for appointments etc.) via phone at
(615) 808-0400.
Mr Samuel C Moore is licensed to practice in Tennessee (license number 29580) and he also participates in the medicare program. He does not accept medicare assignments directly but he may accept medicare through third-party (refer to Reassignment section below) and may also prescribe medicare part D drugs. His NPI Number is 1659048460.
Physician's Profile
| Full Name | Mr Samuel C Moore |
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| Gender | Male |
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| Speciality | Nurse Practitioner - Family |
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| Location | 140 Macon Way, Hartsville, Tennessee |
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| Accepts Medicare Assignments | Medicare enrolled and may accept medicare through third-party reassignment. May prescribe medicare part D drugs. |
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NPI Data:
- NPI Number: 1659048460
- Provider Enumeration Date: 08/28/2021
- Last Update Date: 06/13/2025
Medicare PECOS Information:
- PECOS PAC ID: 5294121083
- Enrollment ID: I20220404001296
Medical Identifiers
Medical identifiers for Mr Samuel C Moore such as npi, medicare ID, medicare PIN, medicaid, etc.
| Identifier | Type | State | Issuer |
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| 1659048460 | NPI | - | NPPES |
Medical Taxonomies and Licenses
| Taxonomy | Type | License (State) | Status |
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| 207Q00000X | Family Medicine | 29580 (Tennessee) | Secondary |
| 2084P0800X | Psychiatry & Neurology - Psychiatry | 29580 (Tennessee) | Secondary |
| 363LF0000X | Nurse Practitioner - Family | 3016346 (Kentucky) | Secondary |
| 363LF0000X | Nurse Practitioner - Family | 29580 (Tennessee) | 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. Mr Samuel C Moore allows following entities to bill medicare on his behalf.
| Entity Name | App Of Tennessee Ed Pllc |
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| Entity Type | Part B Supplier - Clinic/group Practice |
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| Entity Identifiers | NPI Number: 1003230236
PECOS PAC ID: 8123251766
Enrollment ID: O20140506000159 |
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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. Mr Samuel C 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 |
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Mr Samuel C Moore, PMHNP FNP-C
3024 Business Park Cir,
Goodlettsville, TN 37072-3132
Ph: (615) 239-2018 | Mr Samuel C Moore, PMHNP FNP-C
140 Macon Way,
Hartsville, TN 37074-2080
Ph: (615) 808-0400 |
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