Individual provider Active NPI

Matthew Moon

  • Diagnostic Radiology Physician
  • Baltimore, MD
National Provider Identifier
1063702603
Registry record updated Aug 9, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Diagnostic Radiology PhysicianTaxonomy code 2085R0202X
License
D81267 Issued in MD
Practice address
601 N Caroline St
Baltimore, MD 21287-0006
Phone
(410) 955-9446
NPI assigned
Apr 16, 2011
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 9, 2017

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Diagnostic Radiology Physician 2085R0202X C1-0010155 DE
Diagnostic Radiology Physician 2085R0202X D81267 MD Primary

Addresses

Primary practice location

601 N Caroline St
Baltimore, MD 21287-0006

Mailing address

4755 Ogletown Stanton Rd
Newark, DE 19718-2200

Other identifiers 1

IdentifierTypeStateIssuer
108076800MedicaidMD

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MD, DE, PA3 enrollments
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 3

Enrollment IDStateProvider typePAC IDDetails
I20160629001250 MD Practitioner - Diagnostic Radiology 0648418798 Reassigns benefits to 1 organization
I20170727001170 DE Practitioner - Diagnostic Radiology 0648418798 Reassigns benefits to 2 organizations
I20171011001762 PA Practitioner - Diagnostic Radiology 0648418798 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Diagnostic Radiology
Education
Icahn School of Medicine at Mount Sinai, 2011
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Christiana Care Health Services IncGroup PAC ID 9739097569, shared by 25 NPIs, 1,480 clinicians
Christiana Care Pennsylvania IncGroup PAC ID 8921549973, 176 clinicians

Practice addresses (Care Compare)

110 Wedgewood Dr
Chadds Ford, PA 19317-9325
Phone (302) 733-1806

4755 Ogletown Stanton Rd
Newark, DE 19718-2200

900 W Baltimore Pike
Suite 102
West Grove, PA 19390-9313
Phone (302) 838-3088

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
D81267MDMDDiagnostic Radiology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Christiana Care Health Services Inc CurrentSince Jul 16, 2017 Accepting new patients
Christiana Care Health Services, Inc Current Accepting new patients
Johns Hopkins University Current Accepting new patients
Johns Hopkins University CurrentSince Jul 1, 2016 Accepting new patients
Johns Hopkins University Diagnostic Radiology CurrentSince Jul 1, 2016 Accepting new patients
Christiana Care Pennsylvania Inc Diagnostic Radiology Current Accepting new patients
Christiana Care Health Services Inc CurrentSince Aug 6, 2017 Accepting new patients
Christiana Care Pennsylvania Inc CurrentSince Oct 1, 2024 Accepting new patients
Christiana Care Health Services Inc Current Accepting new patients
Christiana Care Pennsylvania Inc CurrentSince Oct 1, 2024 Accepting new patients
Christiana Care Health Services Inc Diagnostic Radiology CurrentSince Jul 16, 2017 Accepting new patients
Christiana Care Health Services Inc Diagnostic Radiology CurrentSince Jul 16, 2017 Accepting new patients

Locations

4755 Ogletown Stanton Rd
Newark, DE 19718
Phone (302) 733-1700

601 N Caroline St
Baltimore, MD 21287
Phone (410) 955-5080

5755 Cedar Ln
Columbia, MD 21044
Phone (410) 381-7171

161 Wilmington W Chester Pike
Ste 1400
Chadds Ford, PA 19317
Phone (610) 361-1145

161 Wilmington W Chester Pike
#P
Chadds Ford, PA 19317
Phone (610) 361-1042

900 W Baltimore Pike
Ste 102
West Grove, PA 19390
Phone (302) 838-3088

Organizations & group practices 12

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.

Hospital & facility affiliations 3

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1302912000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1502236800000",
    "number": "1063702603",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4755 OGLETOWN STANTON RD",
            "city": "NEWARK",
            "state": "DE",
            "postal_code": "197182200"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "601 N CAROLINE ST",
            "city": "BALTIMORE",
            "state": "MD",
            "postal_code": "212870006",
            "telephone_number": "410-955-9446"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MOON",
        "first_name": "MATTHEW",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2011-04-16",
        "last_updated": "2017-08-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2085R0202X",
            "taxonomy_group": "",
            "desc": "Radiology, Diagnostic Radiology",
            "state": "DE",
            "license": "C1-0010155",
            "primary": false
        },
        {
            "code": "2085R0202X",
            "taxonomy_group": "",
            "desc": "Radiology, Diagnostic Radiology",
            "state": "MD",
            "license": "D81267",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "108076800",
            "state": "MD"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Baltimore, MD

Sources for this page

Verify at the official NPI Registry.