MS. MARY SUE MOORE (PMHNP) – Family Nurse Practitioner, NPI 1508221284
Family Nurse Practitioner
Main info
Doctor Profile
Profile Insights
NPPES metrics only — not quality of care.
24,500 NURSE PRACTITIONER in FL
Provider Addresses for MS. MARY SUE MOORE (PMHNP)
20370 NE BURNS AVE
BLOUNTSTOWN, FL 324241045
Phone: (850) 674-5411
Type: Location
20370 NE Burns Ave
Blountstown, FL 324241045
Phone: (850) 674-5411
Type: Location
11523 SW MCCLELLAN FARM RD
CLARKSVILLE, FL 324303043
Phone: (850) 899-3191
Type: Mailing
401 CECIL G COSTIN SR BLVD
PORT ST JOE, FL 324561928
Phone: (850) 229-1043
Type: Location
NPPES updates history
No NPPES updates recorded for this provider.
Prescription Activity
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Open Payments (CMS)
CMS reports 6 Open Payments records for all available years, with a total value of $102.
Total Amount is formed as General ($102) + Research ($0) + Ownership ($0) = $102.
Last reported payment date: 2024-12-31 • Largest payer in this snapshot: Exact Sciences Corporation ($44).
Total Amount
$102
General + Research + Ownership
Payments
6
Total payment records
General Amount
$102
General payments
Research Amount
$0
Research funding
Ownership Amount
$0
Ownership interests
Ownership Count
0
Ownership records
Last Payment Date
2024-12-31
Latest reported date
Top Companies
Largest payers in this snapshot
| Company | Amount |
|---|---|
| Exact Sciences Corporation | $44 |
| Abbott Laboratories | $37 |
| Teva Pharmaceuticals USA, Inc. | $20 |
Medicare Enrollment & Revalidation
Source: CMS public data · Not endorsed by CMS ·
Educational use only—not medical, billing, or legal advice.
PECOS enrollment status
Participating (accepts Medicare assignment)
Enrollment effective: 2018-12-26
PECOS data refreshed: 2026-06-15
Medicare revalidation (CMS due date list)
Due date not assigned yet
CMS is tracking this Medicare enrollment for revalidation, but has not published a due date.
Enrollment records
1
Earliest due date
Not assigned (TBD)
CMS data updated
2026-06-01
Revalidation progress
- Medicare enrolled
- On CMS revalidation list
- Due date assigned
- Revalidate in PECOS
CMS enrollment records
| Enrollment ID | Type | Specialty | State | Due date |
|---|---|---|---|---|
| I20181226001491 | I | Nurse Practitioner | FL | TBD |
What to do next
- No action required while the due date shows TBD.
- Check the CMS Revalidation Lookup Tool periodically — CMS updates the list about every 60 days.
- Do not submit a revalidation application in PECOS until CMS publishes a concrete due date.
Prepare CMS-855 application → · Look up this NPI in PECOS → · Verify on CMS PECOS
Medicare Utilization (FFS)
Source: CMS public data · Not endorsed by CMS · Beneficiary counts under 11 are suppressed in source data ·
Educational use only—not medical, billing, or legal advice.
No Medicare fee-for-service utilization data available for this provider in our database.
Insurance plans in this area (ZIP 32424)
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Group practice members
| Name | Specialty | State |
|---|---|---|
| Physician Assistant | FL | |
| Nurse Practitioner | FL | |
| Clinical Social Worker | FL | |
| - | FL | |
| Physician Assistant | FL | |
| General Practice, Family Practice | FL | |
| Clinical Social Worker | FL | |
| Nurse Practitioner | FL | |
| Nurse Practitioner | FL | |
| General Practice | FL |
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