AMY MOORE (RD, LD, CDE) – Pediatric Nutrition Registered Dietitian, NPI 1801010095
Pediatric Nutrition Registered Dietitian
Main info
Doctor Profile
Profile Insights
NPPES metrics only — not quality of care.
106 REGISTERED DIETITIAN OR NUTRITION PROFESSIONAL in OK
Provider Addresses for AMY MOORE (RD, LD, CDE)
940 North East 13th Street
2B2426
Oklahoma City, OK 731045008
Phone: (405) 271-6764
Type: Location
PO BOX 30589
MIDWEST CITY, OK 731403589
Phone: (405) 769-3301
Type: Mailing
12716 N.E. 36TH STREET
OKLAHOMA CITY, OK 73140
Phone: (405) 769-3301
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: 2010-10-21
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 |
|---|---|---|---|---|
| I20101021001016 | I | Registered Dietitian Or Nutrition Professional | OK | 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 73104)
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Group practice members
| Name | Specialty | State |
|---|---|---|
| Internal Medicine | OK | |
| Family Practice | OK | |
| Family Practice | OK | |
| Family Practice | OK | |
| Nurse Practitioner | OK | |
| Family Practice | OK | |
| - | OK | |
| Clinical Social Worker | OK |
Reviews
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