ANN ROBERTS MOORE (NP) – Family Nurse Practitioner, NPI 1104167386
Family Nurse Practitioner
Main info
Doctor Profile
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Profile Insights
NPPES metrics only — not quality of care.
8,191 NURSE PRACTITIONER in IN
Provider Addresses for ANN ROBERTS MOORE (NP)
7916 W Jefferson Blvd
Fort Wayne, IN 468044140
Phone: (260) 432-2297
Fax: (260) 434-6433
Type: Location
6920 POINTE INVERNESS WAY STE 200
FORT WAYNE, IN 468047934
Phone: (260) 479-3514
Fax: (260) 479-3520
Type: Mailing
3245 HEALTH DRIVE
SUITE 100
GRANGER, IN 465303245
Phone: (574) 647-1840
Fax: (260) 479-3520
Type: Mailing
500 ARCADE AVE
STE 210
ELKHART, IN 465142485
Phone: (574) 389-5656
Fax: (574) 523-7891
Type: Location
7916 W JEFFERSON BLVD
FORT WAYNE, IN 468044140
Phone: (260) 432-2297
Fax: (260) 434-6433
Type: Location
NPPES updates history
No NPPES updates recorded for this provider.
Prescription Activity
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Open Payments (CMS)
No Open Payments data available for this provider.
This can happen when there are no reportable CMS Open Payments records.
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: 2025-12-04
PECOS data refreshed: 2026-05-27
Medicare revalidation (CMS due date list)
Due date not assigned yet
CMS is tracking 7 Medicare enrollment records; no due dates published yet.
Enrollment records
7
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 |
|---|---|---|---|---|
| I20180309001349 | I | Nurse Practitioner | IN | TBD |
| I20250408002075 | I | Nurse Practitioner | AZ | TBD |
| I20250505001666 | I | Nurse Practitioner | NC | TBD |
| I20250718003796 | I | Nurse Practitioner | IA | TBD |
| I20250822003418 | I | Nurse Practitioner | WV | TBD |
| I20250829001392 | I | Nurse Practitioner | MI | TBD |
| I20251204000510 | I | Nurse Practitioner | VA | 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 46804)
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Group practice members
| Name | Specialty | State |
|---|---|---|
| Internal Medicine | OH | |
| H O S P I T A L I S T | NC | |
| Nurse Practitioner | NC | |
| Physician Assistant | NC | |
| Internal Medicine | NM | |
| Physician Assistant | NC | |
| Internal Medicine | OH | |
| Nurse Practitioner | NC | |
| Internal Medicine, Hospitalist | NC | |
| Internal Medicine | OH |
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