Charles M. Moon, MD

Primary specialty

Dermatology PhysicianTaxonomy code 207N00000X

License

2007038037 Issued in MO

Practice address

1359 N Mount Auburn Rd
Cape Girardeau, MO 63701-1727

Phone

(573) 335-7546

Fax

(573) 335-7550

NPI assigned

Dec 5, 2006

Sex

Male

Sole proprietor

Yes

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

Enrolled in MO

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

Specialty

Dermatology

Education

University of Missouri, Columbia School of Medicine, 1999

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Advanced Dermatology of Southeast Missouri PCGroup PAC ID 3678612108, 9 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Mercy Hospital Southeast Hospital, Cape Girardeau, MO, CCN 260110
• Saint Francis Medical Center Hospital, Cape Girardeau, MO, CCN 260183
• Mercy Hospital Stoddard Hospital, Dexter, MO, CCN 260160
• Mercy Hospital Perry Hospital, Perryville, MO, CCN 261311

Merit-based Incentive Payment System (MIPS)

Final score

100 of 100Reported as group

Quality

100

Improvement activities

40

Cost

100

Procedures performed for Medicare patients

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

Interoperability endpoints

• FHIR API: https://fhir.nextgen.com/nge/prod/fhir-api-r4/fhir/r4/

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.

• Advanced Dermatology of Southeast Missouri PC

  • Dermatology Physician
  • Cape Girardeau, MO
  • NPI 1770713950
  Medicare reassignment Care Compare group NPD Authorized official
• Neurologic Associates of Cape Girardeau, Inc

  • Neurology Physician
  • Cape Girardeau, MO
  • NPI 1053435719
  NPD (past)
• Associates in Dermatology, PLLC

  • Dermatology Physician
  • Louisville, KY
  • NPI 1629083399
  NPD (past)

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

• Mercy Hospital Perry

  • Critical Access Hospital
  • Perryville, MO
  • NPI 1063117158
  Care Compare affiliation
• Saint Francis Medical Center

  • General Acute Care Hospital
  • Cape Girardeau, MO
  • NPI 1467412726
  Care Compare affiliation
• Saint Francis Medical Center

  • Internal Medicine Physician
  • Cape Girardeau, MO
  • NPI 1578513016

  Hospital

  Care Compare affiliation
• Southeast Health Center of Stoddard County, LLC

  • General Acute Care Hospital
  • Dexter, MO
  • NPI 1801990825
  Care Compare affiliation
• Southeast Hospital

  • General Acute Care Hospital
  • Cape Girardeau, MO
  • NPI 1811006661
  Care Compare affiliation

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

{
    "created_epoch": "1165276800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1485820800000",
    "number": "1487712295",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2116 MEGAN DR",
            "address_2": "STE 102",
            "city": "CAPE GIRARDEAU",
            "state": "MO",
            "postal_code": "637011979",
            "telephone_number": "573-335-7546",
            "fax_number": "573-335-7550"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1359 N MOUNT AUBURN RD",
            "city": "CAPE GIRARDEAU",
            "state": "MO",
            "postal_code": "637011727",
            "telephone_number": "573-335-7546",
            "fax_number": "573-335-7550"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MOON",
        "first_name": "CHARLES",
        "middle_name": "M.",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-12-05",
        "last_updated": "2017-01-31",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207N00000X",
            "taxonomy_group": "",
            "desc": "Dermatology",
            "state": "IN",
            "license": "01053751A",
            "primary": false
        },
        {
            "code": "207N00000X",
            "taxonomy_group": "",
            "desc": "Dermatology",
            "state": "MO",
            "license": "2007038037",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Stephanie Moll, APRN-FNP-BC
• Gina Monaco, M.D., PH.D.
• Crystal Dawn Montgomery, LCSW
• Emily Clare Montgomery
• Jazzmine Madison Moody
• Andrew Jacob Moore, M.D.
• Brianna Claire Moore
• Colleen Johnson Moore, M.D.
• Dana Marie Moore, APRN
• Donnellya Moore

• Dermatology Physician in Cape Girardeau, MO
• Providers in Cape Girardeau, MO by specialty
• Dermatology Physician in Missouri

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 31, 2017; 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.

Verify at the official NPI Registry.