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Deactivated NPI 1093931768 Deactivated / Inactive NPI Male Practitioner

Dr. Benjamin Luther Moore , PhD

Psychologist - Clinical • Bloomington, IL

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Notice of NPI Deactivation & Inactive Practice Status

According to official public domain records published by CMS (Centers for Medicare & Medicaid Services) in the National Provider Identifier (NPPES) Registry, Dr. Benjamin Moore has officially deactivated this NPI record and ceased active healthcare practice.

Registration / Start Date April 18, 2007
NPI Deactivation Date November 13, 2017
Total Practice Duration ~10 Years of Practice (2007 – 2017)

Professional Overview & Biography Verified Profile Summary

Dr. Benjamin Moore, PhD was a registered Psychologist - Clinical practicing in Bloomington, IL. Throughout an active medical career spanning 10 years, Dr. Moore provided care at the practice location at 105 N REGENCY DR until profile deactivation on 2017-11-13.

Practice Location & Contact Primary Location

Practice Address

105 N Regency Dr

Bloomington, IL 617013515

Telephone 3096638272
Associated Practice Facility / Clinic
🏢 Joseph M. Pope D.d.s.,ltd. Facility NPI 1538369954

Specialty Benchmarks & Practice Insights

Comparative analytics for Psychologist - Clinical in Bloomington, IL

Active Practitioner
Practitioner Clinical Experience
Active
City Avg: 18.7 Yrs
State Avg: 24.2 Yrs
Regional Practice Density
36 Specialists

Practicing in Bloomington, IL (4140 Statewide)

Telehealth Adoption Rate
16.7% Regional Adoption

In-Person Office Visits Only

Medicare Pricing Discount
67.4% Avg Savings

Under CMS Medicare Fee Schedule vs Standard Submitted Charges

Medical Specialties & State Licenses

Psychologist - Clinical Primary Specialty

NUCC Taxonomy Code: 103TC0700X

A psychologist who provides continuing and comprehensive mental and behavioral health care for individuals and families; consultation to agencies and communities; training, education and supervision; and research-based practice. It is a specialty in breadth -- one that is broadly inclusive of severe psychopathology -- and marked by comprehensiveness and integration of knowledge and skill from a broad array of disciplines within and outside of psychology proper. The scope of clinical psychology encompasses all ages, multiple diversities and varied systems.

Practice Associates & Co-Workers

Healthcare professionals and specialists practicing at this location or sharing practice phone/fax

1 Associated Practitioners
Dr. Joseph Pope , DDS

Dentist - General Practice

NPI 1720288384

Doctor of Dental Surgery

Career & Practice History Timeline

Chronological log of verified NPI updates, location relocations, credentials, and registry changes

7 Historical Events
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NPI Profile Deactivated November 13, 2017

Record deactivated on November 13, 2017

NPI Profile Active July 08, 2007

NPI status registered as active in NPPES database

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Updated Practice Location July 08, 2007

Registered at 105 N REGENCY DR, BLOOMINGTON, IL 617013515 (Tel: 3096638272)

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Updated Business Mailing Address July 08, 2007

Registered at 105 N REGENCY DR, BLOOMINGTON, IL 617013515 (Tel: 3096638272)

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Provider Name / Credentials Updated July 08, 2007

Recorded as BENJAMIN MOORE, PH.D.

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Medical Taxonomy / Specialty Registered (Primary Specialty) July 08, 2007

Psychologist

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Initial NPI Registration & Enumeration April 18, 2007

First registered as active Individual Practitioner in NPPES Database.

Patient & Community Reviews

Verified patient ratings, medical care experiences, and facility photos

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NPI Administrative Meta

NPI Number: 1093931768
Entity Type:
Individual Provider Physician, Nurse Practitioner, or Solo Healthcare Professional (Type 1 NPI)
Enumeration Date: April 18, 2007
Last Update: July 08, 2007
Deactivation Date: November 13, 2017

Mailing Address

105 N Regency Dr

Bloomington, IL 617013515

Phone: 3096638272

Public Domain Record This profile contains public domain information published by CMS and NPPES under the Freedom of Information Act (FOIA).
⚠️ Medical Disclaimer

This directory listing is for informational purposes only and does not constitute medical advice, diagnosis, or physician endorsement. If you are experiencing a medical emergency, please call 911 immediately.