DR. NICHOLAS VENCENZO MOORE (DO) – Internal Medicine Physician, NPI 1104492529
Internal Medicine Physician
Main info
Doctor Profile
Profile Insights
NPPES metrics only — not quality of care.
7,218 INTERNAL MEDICINE in MI
Provider Addresses for DR. NICHOLAS VENCENZO MOORE (DO)
5674 ORTMAN DR
STERLING HEIGHTS, MI 483142070
Phone: (586) 850-4026
Type: Mailing
11885 E 12 MILE RD STE 300A
WARREN, MI 480933467
Phone: (586) 852-6630
Type: Location
2923 SPARTA DR
TROY, MI 480836406
Phone: (586) 850-4026
Type: Mailing
2333 BIDDLE AVE
WYANDOTTE, MI 481924668
Phone: (734) 246-6000
Type: Location
NPPES updates history
No NPPES updates recorded for this provider.
Prescription Activity
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Open Payments (CMS)
CMS reports 1 Open Payments records for all available years, with a total value of $130.
Total Amount is formed as General ($130) + Research ($0) + Ownership ($0) = $130.
Last reported payment date: 2023-04-11 • Largest payer in this snapshot: Boston Scientific Corporation ($130).
Total Amount
$130
General + Research + Ownership
Payments
1
Total payment records
General Amount
$130
General payments
Research Amount
$0
Research funding
Ownership Amount
$0
Ownership interests
Ownership Count
0
Ownership records
Last Payment Date
2023-04-11
Latest reported date
Top Companies
Largest payers in this snapshot
| Company | Amount |
|---|---|
| Boston Scientific Corporation | $130 |
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: 2024-09-25
PECOS data refreshed: 2026-05-27
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 |
|---|---|---|---|---|
| I20240925001741 | I | Internal Medicine | MI | 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 48314)
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Group practice members
| Name | Specialty | State |
|---|---|---|
| Family Practice | MI | |
| Emergency Medicine | MI | |
| Family Practice | MI | |
| Physician Assistant | MI | |
| Family Practice | MI | |
| Physician Assistant | MI | |
| Emergency Medicine | MI | |
| Nurse Practitioner | MI | |
| Nurse Practitioner | MI | |
| Physician Assistant | MI |
Reviews
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