Individual provider Active NPI

Martin Ryan Moon, M.D.

  • Surgery Physician
  • Florence, KY
National Provider Identifier
1174516934
Registry record updated Nov 18, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Surgery PhysicianTaxonomy code 208600000X
License
39444 Issued in KY
Practice address
4900 Houston Rd
Florence, KY 41042-4824
Phone
(859) 578-5880
Fax
(859) 578-5881
NPI assigned
Aug 26, 2005
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 18, 2021

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Surgery Physician 208600000X 35-070819 OH
Surgery Physician 208600000X 39444 KY Primary

Addresses

Primary practice location

4900 Houston Rd
Florence, KY 41042-4824

Mailing address

PO Box 635283
Cincinnati, OH 45263-5283
Phone (859) 578-5800

Other identifiers 1

IdentifierTypeStateIssuer
64108491MedicaidKY

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in KY
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 1

Enrollment IDStateProvider typePAC IDDetails
I20050920000055 KY Practitioner - General SurgeryPractitioner - Thoracic Surgery 9931133006 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
General SurgeryAlso: Thoracic Surgery
Education
Creighton University School of Medicine, 1994
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Summit Medical Group IncGroup PAC ID 2163326240, 803 clinicians

Practice addresses (Care Compare)

7370 Turfway Rd
Florence, KY 41042-4895
Phone (859) 212-5125

Hospital & facility affiliations

  • St Elizabeth Florence Hospital, Florence, KY, CCN 180045
  • St Elizabeth Edgewood Hospital, Edgewood, KY, CCN 180035
  • St Elizabeth Ft Thomas Hospital, Fort Thomas, KY, CCN 180001
  • St Elizabeth Grant Hospital, Williamstown, KY, CCN 181311

Merit-based Incentive Payment System (MIPS)

Final score
93.01 of 100Reported as apm
Quality
86.02
Promoting interoperability
100
Improvement activities
40

Procedures performed for Medicare patients

ProcedureNumber of procedures
Colonoscopy1-10
Hernia repair - groin (open)1-10
Hernia repair (minimally invasive)22
Upper gastrointestinal (GI) endoscopy for acid reflux1-10
Removal of tissue1-10

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
35-070819OHMDSurgery Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Summit Medical Group, Inc Surgery CurrentSince Aug 1, 2011 Accepting new patients
Summit Medical Group, Inc. CurrentSince Aug 1, 2011 Accepting new patients
St Elizabeth Medical Center, Inc Past Accepting new patients
Lima Memorial Joint Operating Company Past Accepting new patients
Advanced Surgical Care Past Accepting new patients

Locations

401 E 20th St
Covington, KY 41014
Phone (859) 283-6600

334 Thomas More Pkwy
Crestview Hills, KY 41017
Phone (859) 331-6065

20 Medical Village Dr
Edgewood, KY 41017
Phone (859) 344-1600

20 Medical Village Dr
Ste 105
Edgewood, KY 41017
Phone (859) 426-7000

20 Medical Village Dr
Ste 132
Edgewood, KY 41017
Phone (606) 572-4400

4900 Houston Rd
Florence, KY 41042
Phone (859) 212-5200

7370 Turfway Rd
Florence, KY 41042
Phone (859) 212-5125

7370 Turfway Rd
Ste 150
Florence, KY 41042
Phone (859) 212-4450

1980 Litton Ln
Hebron, KY 41048
Phone (859) 334-8700

300 Barnes Rd
Williamstown, KY 41097
Phone (859) 824-8217

238 Barnes Rd
Williamstown, KY 41097
Phone (859) 292-4000

Interoperability endpoints

  • Direct secure messaging: mmoon27374@direct-prd.stelizabeth.com

Organizations & group practices 5

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 4

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": "1125014400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1637193600000",
    "number": "1174516934",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 635283",
            "city": "CINCINNATI",
            "state": "OH",
            "postal_code": "452635283",
            "telephone_number": "859-578-5800",
            "fax_number": "589-578-5881"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4900 HOUSTON RD",
            "city": "FLORENCE",
            "state": "KY",
            "postal_code": "410424824",
            "telephone_number": "859-578-5880",
            "fax_number": "859-578-5881"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MOON",
        "first_name": "MARTIN",
        "middle_name": "RYAN",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-08-26",
        "last_updated": "2021-11-18",
        "certification_date": "2021-11-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208600000X",
            "taxonomy_group": "",
            "desc": "Surgery",
            "state": "OH",
            "license": "35-070819",
            "primary": false
        },
        {
            "code": "208600000X",
            "taxonomy_group": "",
            "desc": "Surgery",
            "state": "KY",
            "license": "39444",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "64108491",
            "state": "KY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Florence, KY

Sources for this page

Verify at the official NPI Registry.