NPIMap

Individual provider Active NPI

David W Moon, M.D.

  • Family Medicine Physician
  • Lake City, SC
National Provider Identifier
1417053133
Registry record updated May 15, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
9839 Issued in SC
Practice address
276 N Ron McNair Blvd
Lake City, SC 29560-2462
Phone
(843) 394-5471
Fax
(843) 394-5459
NPI assigned
Sep 16, 2006
Last updated
May 15, 2014By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 15, 2014

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 9839 SC Primary

Addresses

Primary practice location

276 N Ron McNair Blvd
Lake City, SC 29560-2462

Mailing address

276 N Ron McNair Blvd
Lake City, SC 29560-2462
Phone (843) 394-5471

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in SC
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20050809000040 SC Practitioner - Family Practice 6204865421 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Medical University of South Carolina College of Medicine, 1979
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
McLeod Physician Associates IIGroup PAC ID 8224031307, 541 clinicians

Practice addresses (Care Compare)

800 E Cheves St
Florence, SC 29506-2650

800 E Cheves St
Florence, SC 29506-2652

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Removal of skin lesions14
Removal of nail tissue1-10
Removal or shaving of skin growth1-10

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
9839SCMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
McLeod Health Clarendon Family Medicine CurrentSince Oct 1, 2022 Accepting new patients
McLeod Health Clarendon Family Medicine CurrentSince Oct 1, 2022 Accepting new patients
McLeod Health Clarendon Current Accepting new patients
McLeod Physician Associates II Family Medicine CurrentSince Oct 1, 2022 Accepting new patients
McLeod Physician Associates II CurrentSince Oct 1, 2022 Accepting new patients
McLeod Physician Associates II Family Medicine Past Accepting new patients

Locations

800 E Cheves St
Ste 240
Florence, SC 29506
Phone (843) 777-7950

800 E Cheves St
Ste 480A
Florence, SC 29506
Phone (843) 777-7337

355 S Georgetown Hwy
Johnsonville, SC 29555
Phone (843) 380-2000

276 N Ron McNair Blvd
Lake City, SC 29560
Phone (843) 394-1051

10 E Hospital St
Manning, SC 29102
Phone (803) 433-3000

Interoperability endpoints

  • Direct secure messaging: dmoon40446@directmcleodehealth.org

Organizations & group practices 6

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

Hospital & facility affiliations 7

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": "1158364800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1400112000000",
    "number": "1417053133",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "276 N RON MCNAIR BLVD",
            "city": "LAKE CITY",
            "state": "SC",
            "postal_code": "295602462",
            "telephone_number": "843-394-5471",
            "fax_number": "843-394-5459"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "276 N RON MCNAIR BLVD",
            "city": "LAKE CITY",
            "state": "SC",
            "postal_code": "295602462",
            "telephone_number": "843-394-5471",
            "fax_number": "843-394-5459"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MOON",
        "first_name": "DAVID",
        "middle_name": "W",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-09-16",
        "last_updated": "2014-05-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "SC",
            "license": "9839",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Lake City, SC

Sources for this page

Verify at the official NPI Registry.