Individual provider Active NPI

Joon-Shik Moon, MD

  • Neurology Physician
  • Oklahoma City, OK
National Provider Identifier
1518074780
Registry record updated Jan 30, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Neurology PhysicianTaxonomy code 2084N0400X
License
26756 Issued in OK
Practice address
921 NE 13TH St
Oklahoma City, OK 73104-5007
Phone
(405) 456-3235
Fax
(405) 456-1504
NPI assigned
Aug 24, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 30, 2024

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Neurology Physician 2084N0400X 102375 MN
Neurology Physician 2084N0400X 26756 OK Primary

Addresses

Primary practice location

921 NE 13TH St
Oklahoma City, OK 73104-5007

Mailing address

1122 NE 13TH St
Ori 236
Oklahoma City, OK 73117-1039
Phone (405) 456-3235

Other practice location 1

920 Stanton L Young Blvd Ste 2040
Oklahoma City, OK 73104-5036
Phone (405) 271-4113

Other identifiers 1

IdentifierTypeStateIssuer
963468000MedicaidMN

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OK
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

Enrollment IDStateProvider typePAC IDDetails
I20090909000063 OK Practitioner - Neurology 9032114780 Reassigns benefits to 2 organizations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
26756OKMDNeurology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Board of Regents of the University of Oklahoma - Ou Physicians CurrentSince Aug 11, 2009 Accepting new patients
Ou Health Partners, Inc CurrentSince Jul 1, 2021 Accepting new patients
Ou Health Partners, Inc CurrentSince Jul 1, 2021 Accepting new patients
Board of Regents of the University of Oklahoma - Ou Physicians CurrentSince Aug 11, 2009 Accepting new patients
Board of Regents of the Univ of Oklahoma Past Accepting new patients
Summit Medical Center Past Accepting new patients

Locations

825 NE 10th St
Oklahoma City, OK 73104
Phone (405) 271-4864

920 Stanton L Young Blvd
Ste 2040
Oklahoma City, OK 73104
Phone (405) 271-4113

825 NE 10th St
Ste 5200
Oklahoma City, OK 73104
Phone (405) 271-3635

711 Stanton L Young Blvd
Ste 210
Oklahoma City, OK 73104
Phone (405) 271-3635

900 NE 10th St
Oklahoma City, OK 73104
Phone (405) 271-2230

Interoperability endpoints

  • Direct secure messaging: jmoon22585@ouhealth.direct-ci.net

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 and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1156377600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1706572800000",
    "number": "1518074780",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1122 NE 13TH ST",
            "address_2": "ORI 236",
            "city": "OKLAHOMA CITY",
            "state": "OK",
            "postal_code": "731171039",
            "telephone_number": "405-456-3235",
            "fax_number": "405-456-1504"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "921 NE 13TH ST",
            "city": "OKLAHOMA CITY",
            "state": "OK",
            "postal_code": "731045007",
            "telephone_number": "405-456-3235",
            "fax_number": "405-456-1504"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "920 Stanton L Young Blvd Ste 2040",
            "address_purpose": "LOCATION",
            "city": "Oklahoma City",
            "state": "OK",
            "postal_code": "731045036",
            "country_code": "US",
            "telephone_number": "405-271-4113",
            "fax_number": "405-271-2523",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "MOON",
        "first_name": "JOON-SHIK",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-08-24",
        "last_updated": "2024-01-30",
        "certification_date": "2024-01-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2084N0400X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Neurology",
            "state": "MN",
            "license": "102375",
            "primary": false
        },
        {
            "code": "2084N0400X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Neurology",
            "state": "OK",
            "license": "26756",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "963468000",
            "state": "MN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Oklahoma City, OK

Sources for this page

Verify at the official NPI Registry.