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

Dr. Jake T Moore, DO

Individual provider Family Medicine Physician · NPI 1730537887

Dr. Jake T Moore, DO is a Family Practice in Bowling Green, Ohio. Graduated from At Still Un of Hlth Sciences, Col of Osteo Med, Mesa in 2016, 10 years ago. Practices with Promedica Central Physicians, a 784-clinician group, works from 2 locations and accepts Medicare assignment. Licensed in Michigan and Ohio.

Years since qualifying
10
Trained at
At Still Un of Hlth Sciences, Col of Osteo Med, Mesa
Licensed in
MI, OH
In the registry since
2016
Specialties on file
2
What do these letters mean?
DO — Doctor of Osteopathic Medicine
A fully licensed physician, trained like an MD with additional musculoskeletal training. Equivalent practice rights in all 50 states.

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Practice location Address checks out

1180 N Main St Ste 5
Bowling Green, OH 43402-4932
Phone: (419) 315-1225
Fax: (419) 315-1226
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Additional practice locations (1)

  • 1 Genesys Pkwy, Grand Blanc, MI 48439-8065 — (801) 755-3422

Specialties & licences

Family Medicine Physician (primary) Taxonomy 207Q00000X · Licence 34.014671 (OH)
Family Medicine Physician Taxonomy 207Q00000X · Licence 5101022457 (MI)

Record details

NPI number1730537887
Entity typeIndividual (Type 1)
GenderMale
Credentials DO
Sole proprietorYes
NPI enumeratedMay 31, 2016
Last updated in NPPESNovember 3, 2023
Certification dateDecember 7, 2020
Mailing address333 N Summit St Fl 7, Toledo, OH 43604-1531

Medicare enrollment

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

Medicare specialtyFAMILY PRACTICE
Medical schoolAT STILL UN OF HLTH SCIENCES, COL OF OSTEO MED, MESA
Graduated 2016 (10 years in practice)
Group practice Promedica Central Physicians — 784 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount

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