DR. JUSTIN DERRICK MOORE (M.D.) – Maternal & Fetal Medicine Physician, NPI 1619323946
Maternal & Fetal Medicine Physician
Main info
Profile Insights
NPPES metrics only — not quality of care.
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Provider Addresses for DR. JUSTIN DERRICK MOORE (M.D.)
5268 LYND AVE
LYNDHURST, OH 441241031
Phone: (810) 223-1330
Type: Mailing
3260, Daleford Road, Shaker Heights, Cuyahoga County, Ohio, 44120, United States
SHAKER HEIGHTS, OH 441203436
Phone: (810) 223-1330
Type: Mailing
Euclid Avenue, East Eightyninth Street Historic District, Hough, Cleveland, Cuyahoga County, Ohio, 44195, United States
CLEVELAND, OH 441952648
Phone: (810) 223-1330
Type: Location
2178 EDGEVIEW DR
HUDSON, OH 442361825
Phone: (810) 223-1330
Type: Mailing
215 W BOWERY ST STE 5
AKRON, OH 443081069
Phone: (330) 543-4500
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: 2024-10-08
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 |
|---|---|---|---|---|
| I20241008000274 | I | Obstetrics/Gynecology | OH | 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 44124)
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