Active NPI
Innkyu Moon, PA-C
- Physician Assistant
- Indianapolis, IN
National Provider Identifier
1326774050
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physician Assistant
- License
- 10005244A
- Practice address
- 1701 Senate Blvd
Indianapolis, IN 46202-1239 - Phone
- (888) 484-3258
- NPI assigned
- Jul 26, 2022
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physician Assistant | 363A00000X | 10005244A | IN | Primary |
Addresses
Primary practice location
1701 Senate Blvd
Indianapolis, IN 46202-1239
Mailing address
250 N Shadeland Ave
Indianapolis, IN 46219-4959
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1104362029 | Other | IN | ANTHEM PTAN |
Electronic endpoints 1
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| Direct Messaging Address | IMOON@DIRECT.IUHEALTH.ORG | Direct |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in NY, IN
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: No
Enrollment records 2
Care Compare profile
Medicare Care Compare- Specialty
- Physician Assistant
- Education
- Other, 2022
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
Practice addresses (Care Compare)
17 E 102ND St
New York, NY 10029-5204
Phone (212) 659-8551
1701 N Senate Blvd
Indianapolis, IN 46202-1239
Phone (888) 484-3258
5 E 98TH St
New York, NY 10029-6501
Phone (212) 241-3150
Hospital & facility affiliations
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Physician Assistant
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 030027 | NY | MD | General Practice Dentistry |
| 10005244A | IN | MD | Physician Assistant |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Icahn School of Medicine at Mount Sinai | Current | Accepting new patients | |
| Icahn School of Medicine at Mount Sinai | Internal Medicine | Current | Accepting new patients |
Locations
17 E 102nd St
New York, NY 10029
Phone (212) 241-7968
1468 Madison Ave
New York, NY 10029
Phone (212) 241-0440
Networks
- Healthfirst Medicare Network H5989
- Healthfirst Medicare Network H3359
- Healthfirst Medicare Network H9678
- Healthfirst Medicare Network H1722
Interoperability endpoints
- imoon@direct.iuhealth.org
Organizations & group practices 4
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.
-
- General Practice Physician
- Indianapolis, IN
- NPI 1326893777
-
- Orthopaedic Surgery Physician
- New York, NY
- NPI 1124550280
-
- Infectious Disease Physician
- New York, NY
- NPI 1659639524
Internal Medicine
-
- Eyewear Supplier
- New York, NY
- NPI 1760227466
Hospital & facility affiliations 6
Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.
-
- General Acute Care Hospital
- Long Island City, NY
- NPI 1245248939
-
- Rehabilitation Hospital
- New York, NY
- NPI 1669440327
-
- General Acute Care Hospital
- New York, NY
- NPI 1932103413
-
- General Acute Care Hospital
- New York, NY
- NPI 1225295512
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1658793600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1780358400000",
"number": "1326774050",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "250 N SHADELAND AVE",
"city": "INDIANAPOLIS",
"state": "IN",
"postal_code": "462194959"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1701 SENATE BLVD",
"city": "INDIANAPOLIS",
"state": "IN",
"postal_code": "462021239",
"telephone_number": "888-484-3258"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MOON",
"first_name": "INNKYU",
"credential": "PA-C",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2022-07-26",
"last_updated": "2026-06-02",
"certification_date": "2026-06-02",
"status": "A"
},
"taxonomies": [
{
"code": "363A00000X",
"taxonomy_group": "",
"desc": "Physician Assistant",
"state": "IN",
"license": "10005244A",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "ANTHEM PTAN",
"identifier": "1104362029",
"state": "IN"
}
],
"endpoints": [
{
"endpointType": "DIRECT",
"endpointTypeDescription": "Direct Messaging Address",
"endpoint": "IMOON@DIRECT.IUHEALTH.ORG",
"affiliation": "N",
"use": "DIRECT",
"useDescription": "Direct",
"address_1": "1701 Senate Blvd",
"city": "Indianapolis",
"state": "IN",
"country_code": "US",
"postal_code": "462021239",
"country_name": "United States",
"address_type": "DOM"
}
],
"other_names": []
}Other providers in Indianapolis, IN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 2, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- 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.