Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
NPIDirectory

Andrew Marc Moore

Individual provider Medical Physician Assistant · NPI 1710462734

Andrew Marc Moore is a Physician Assistant in Beavercreek, Ohio. Graduated from Lincoln Memorial University Medical Department in 2018, 8 years ago. Practices with Kettering Independent Medical Group Inc, a 700-clinician group, works from 2 locations and accepts Medicare assignment. Licensed in Ohio and Tennessee.

Years since qualifying
8
Trained at
Lincoln Memorial University Medical Department
Licensed in
OH, TN
In the registry since
2018
Specialties on file
2
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Practice location Address checks out

3535 Pentagon Blvd
Beavercreek, OH 45431-1705
Phone: (937) 702-4024
Fax: (937) 702-4035
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Additional practice locations (1)

  • 2105 Sherbrooke Ln, Nashville, TN 37211-7029 — (865) 776-8490

Specialties & licences

Physician Assistant (primary) Taxonomy 363A00000X · Licence 50.005821RX (OH)
Medical Physician Assistant Taxonomy 363AM0700X · Licence 3688 (TN)

Record details

NPI number1710462734
Entity typeIndividual (Type 1)
GenderMale
Sole proprietorNo
NPI enumeratedSeptember 25, 2018
Last updated in NPPESJanuary 12, 2021
Certification dateJanuary 12, 2021
Mailing address2105 Sherbrooke Ln, Nashville, TN 37211-7029

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyPHYSICIAN ASSISTANT
Medical schoolLINCOLN MEMORIAL UNIVERSITY MEDICAL DEPARTMENT
Graduated 2018 (8 years in practice)
Group practice Kettering Independent Medical Group Inc — 700 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount
Practice locations4 on file with Medicare

Other providers in Beavercreek