Individual provider Active NPI

You Jong Alyssa Moon, FNP-C

  • Family Nurse Practitioner
  • Charlotte, NC
National Provider Identifier
1033696141
Registry record updated Sep 20, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
5016355 Issued in NC
Practice address
6429 Bannington Rd Ste B
Charlotte, NC 28226-1345
Phone
(704) 503-9338
Fax
(704) 503-9339
NPI assigned
Jul 21, 2018
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 20, 2024

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X 0024176271 VA
Family Nurse Practitioner 363LF0000X 5016355 NC Primary

Addresses

Primary practice location

6429 Bannington Rd Ste B
Charlotte, NC 28226-1345

Mailing address

6429 Bannington Rd Ste B
Charlotte, NC 28226-1345
Phone (704) 503-9338

Other practice location 1

4100 Carmel Rd
Charlotte, NC 28226-6150
Phone (704) 542-9210

Other practice location 2

1721 Admiral Taussig Blvd
Norfolk, VA 23511-2802
Phone (757) 953-9000

Other practice location 3

4208 Evergreen Ln Ste 222
Annandale, VA 22003-3251
Phone (703) 642-2288

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

Care Compare profile

Medicare Care Compare

Merit-based Incentive Payment System (MIPS)

Final score
85.46 of 100Reported as group
Quality
80.45
Improvement activities
40
Cost
87.37

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

Practice roles

OrganizationSpecialtyStatusNew patients
Peter D Kim MD PC CurrentSince Aug 1, 2019 Accepting new patients
Amara Pain & Spine PLLC CurrentSince Apr 14, 2024 Accepting new patients

Locations

6429 Bannington Rd
Ste B
Charlotte, NC 28226
Phone (704) 503-9338

4208 Evergreen Ln
Ste 222
Annandale, VA 22003
Phone (703) 642-2288

Interoperability endpoints

  • FHIR API: https://api.platform.athenahealth.com/8476/brand/1/csg/1/fhir/r4

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1532131200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1726790400000",
    "number": "1033696141",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6429 BANNINGTON RD STE B",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282261345",
            "telephone_number": "704-503-9338",
            "fax_number": "704-503-9339"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6429 BANNINGTON RD STE B",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282261345",
            "telephone_number": "704-503-9338",
            "fax_number": "704-503-9339"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "4100 Carmel Rd",
            "address_purpose": "LOCATION",
            "city": "Charlotte",
            "state": "NC",
            "postal_code": "282266150",
            "country_code": "US",
            "telephone_number": "704-542-9210",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1721 Admiral Taussig Blvd",
            "address_purpose": "LOCATION",
            "city": "Norfolk",
            "state": "VA",
            "postal_code": "235112802",
            "country_code": "US",
            "telephone_number": "757-953-9000",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "4208 Evergreen Ln Ste 222",
            "address_purpose": "LOCATION",
            "city": "Annandale",
            "state": "VA",
            "postal_code": "220033251",
            "country_code": "US",
            "telephone_number": "703-642-2288",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "MOON",
        "first_name": "YOU JONG",
        "middle_name": "ALYSSA",
        "credential": "FNP-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2018-07-21",
        "last_updated": "2024-09-20",
        "certification_date": "2024-09-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "VA",
            "license": "0024176271",
            "primary": false
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "NC",
            "license": "5016355",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Charlotte, NC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 20, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.