Tara Moon, M.D.

Primary specialty

Pediatrics PhysicianTaxonomy code 208000000X

License

2015-01302 Issued in NC

Practice address

1410 Fern Creek Dr
Statesville, NC 28625-9376

Phone

(704) 978-2379

Fax

(704) 978-2380

NPI assigned

Jun 26, 2012

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Electronic endpoints 1

Medicare fee-for-service enrollment

Enrolled in NC

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

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: tara.moon.1@4693.direct.athenahealth.com

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.

• Granville Health System

  • Certified Registered Nurse Anesthetist
  • Oxford, NC
  • NPI 1275638512
  Medicare reassignment NPD
• Scotland Memorial Hospital Inc

  • Vascular Surgery Physician
  • Laurinburg, NC
  • NPI 1477791507
  Medicare reassignment NPD
• Callisto Pediatrics, PLLC

  • Pediatrics Physician
  • Huntersville, NC
  • NPI 1447847975
  NPD Authorized official
• Gateway Community Health Centers, Inc

  • Clinic Pharmacy
  • Gatesville, NC
  • NPI 1447843370
  NPD
• Gateway Community Health Centers, Inc.

  • Federally Qualified Health Center (FQHC)
  • Elizabeth City, NC
  • NPI 1487936514
  NPD
• Granville Health System

  • Diagnostic Radiology Physician
  • Oxford, NC
  • NPI 1104683341
  NPD
• Granville Health System

  • Hospitalist Physician
  • Oxford, NC
  • NPI 1629252986
  NPD
• Scotland Memorial Hospital Inc

  • General Practice Physician
  • Laurinburg, NC
  • NPI 1518951144

  Pediatrics

  NPD

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

{
    "created_epoch": "1340668800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1599696000000",
    "number": "1336403211",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1410 FERN CREEK DR",
            "city": "STATESVILLE",
            "state": "NC",
            "postal_code": "286259376",
            "telephone_number": "704-978-2379",
            "fax_number": "704-978-2380"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1410 FERN CREEK DR",
            "city": "STATESVILLE",
            "state": "NC",
            "postal_code": "286259376",
            "telephone_number": "704-978-2379",
            "fax_number": "704-978-2380"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MOON",
        "first_name": "TARA",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2012-06-26",
        "last_updated": "2020-09-10",
        "certification_date": "2020-09-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "NC",
            "license": "2015-01302",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "tara.moon.1@4693.direct.athenahealth.com",
            "affiliation": "N",
            "endpointDescription": "AMR direct access",
            "address_1": "1410 Fern Creek Dr",
            "city": "Statesville",
            "state": "NC",
            "country_code": "US",
            "postal_code": "286259376",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Alopi Modi, DNP, FNP-BC
• Monarch
• Kera Cosper Mondez, DNP, FNP-C
• Patricia Williamson Monroe, P.T.
• Elisabeth Montague, MD
• Ashley Elizabeth Moore, FNP
• Erin Rochelle Moore, IBCLC, CD-DONA
• Janiyah Renee Moore, LCSWA
• Jennifer Pruitt Moore, L.P.C.
• Karson Collins Moore, AUD

• Pediatrics Physician in Statesville, NC
• Providers in Statesville, NC by specialty
• Pediatrics Physician in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 10, 2020; 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.