Mark Moon, MD

Primary specialty

Internal Medicine PhysicianTaxonomy code 207R00000X

License

35.126007 Issued in OH

Practice address

7707 Paragon Rd Ste 101
Centerville, OH 45459

Phone

(937) 208-6920

Fax

(937) 208-6948

NPI assigned

May 5, 2006

Last updated

Oct 5, 2020By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

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.

Opted out of Medicare

Yes, effective Jul 1, 2023 through Jul 1, 2027

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

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.

• Internal Medicine Associates of Waycross, P.C.

  dba Waycross Internal Medicine

  • Internal Medicine Physician
  • Waycross, GA
  • NPI 1144420530
  NPD (past)

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

{
    "created_epoch": "1146787200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1601856000000",
    "number": "1437107034",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 3266",
            "city": "ST AUGUSTINE",
            "state": "FL",
            "postal_code": "320853266",
            "telephone_number": "904-819-4602",
            "fax_number": "937-223-9811"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7707 PARAGON RD STE 101",
            "city": "CENTERVILLE",
            "state": "OH",
            "postal_code": "45459",
            "telephone_number": "937-208-6920",
            "fax_number": "937-208-6948"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MOON",
        "first_name": "MARK",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-05-05",
        "last_updated": "2020-10-05",
        "certification_date": "2020-09-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "FL",
            "license": "ME79597",
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "OH",
            "license": "35.126007",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Emily Suzanne Monroe, PA-C
• Mark A Monsour, MD
• Brittany Renee Montgomery, CNP
• Anessa Rae Moody
• Dong Soo Moon, M.D.
• Gina Marie Martorana Moran, DPT
• Tyler Robert Mordarski
• Morgan Therapeutics LLC (Morgan Medical Services)
• Alexander Morgan, PTA
• Gwendolyn Angele Morgan, LPC

• Internal Medicine Physician in Centerville, OH
• Providers in Centerville, OH by specialty
• Internal Medicine Physician in Ohio

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 5, 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; Opt Out Affidavits.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.