Individual provider Active NPI

David K. Moon, MD

  • Hospitalist Physician
  • Portland, OR
National Provider Identifier
1609872753
Registry record updated Jul 26, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Hospitalist PhysicianTaxonomy code 208M00000X
License
MD23264 Issued in OR
Practice address
9205 SW Barnes Rd
Portland, OR 97225-6603
Phone
(503) 216-2906
Fax
(503) 216-4114
NPI assigned
Jun 23, 2005
Last updated
Jul 26, 2021By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 26, 2021

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X MD23264 OR
Hospitalist Physician 208M00000X MD23264 OR Primary

Addresses

Primary practice location

9205 SW Barnes Rd
Portland, OR 97225-6603

Mailing address

PO Box 3158
Portland, OR 97208-3158

Other identifiers 3

IdentifierTypeStateIssuer
129981MedicaidOR
8233157MedicaidWA
P00465304OtherORRR MEDICARE

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OR
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
I20071113000522 OR Practitioner - Emergency MedicinePractitioner - Internal MedicinePractitioner - Hospitalist 4981607710 Reassigns benefits to 6 organizations

Care Compare profile

Medicare Care Compare
Specialty
Emergency MedicineAlso: Internal Medicine
Education
University of Arizona College of Medicine, 1995
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

5050 NE Hoyt St
Suite 454
Portland, OR 97213-2984
Phone (503) 215-6405

9205 SW Barnes Rd
Portland, OR 97225-6603
Phone (503) 216-2213

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
MD23264ORMDHospitalist Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Providence Health & Services - Oregon Internal Medicine CurrentSince Apr 4, 2015 Accepting new patients
Providence Health & Services Oregon Current Accepting new patients
Providence Health & Services - Oregon Internal Medicine CurrentSince Apr 4, 2015 Accepting new patients
Salem Health West Valley CurrentSince Nov 14, 2022 Accepting new patients
Western Healthcare Services Texas CurrentSince Sep 1, 2022 Accepting new patients
Providence Health & Services Oregon CurrentSince Apr 4, 2015 Accepting new patients
Providence Health & Service - Oregon CurrentSince Jan 1, 2008 Accepting new patients
Cep America LLC CurrentSince Jan 1, 2025 Accepting new patients
Providence Health & Services Oregon CurrentSince Jan 1, 2008 Accepting new patients
Cep America LLC Current Accepting new patients
Providence Health & Services - Oregon Internal Medicine CurrentSince Apr 4, 2015 Accepting new patients
Cep America LLC CurrentSince Jan 1, 2025 Accepting new patients

Locations

1601 Cummins Dr
Ste D
Modesto, CA 95358
Phone (510) 851-7423

500 5th St
Brookings, OR 97415
Phone (541) 412-2000

9290 SE Sunnybrook Blvd
Ste 210
Clackamas, OR 97015
Phone (503) 216-7960

525 SE Washington St
Dallas, OR 97338
Phone (503) 623-7344

94220 4th St
Gold Beach, OR 97444
Phone (541) 247-3000

1601 Monmouth St
Ste 100
Independence, OR 97351
Phone (503) 623-8301

2801 St Anthony Way
Pendleton, OR 97801
Phone (541) 276-5121

10150 SE 32nd Ave
Portland, OR 97222
Phone (503) 215-4202

1321 NE 99th Ave
Ste 200
Portland, OR 97220
Phone (503) 215-4250

4805 NE Glisan St
Portland, OR 97213
Phone (503) 215-1111

5050 NE Hoyt St
Ste 240
Portland, OR 97213
Phone (503) 215-6480

5050 NE Hoyt St
Ste 454
Portland, OR 97213
Phone (503) 215-6405

9205 SW Barnes Rd
Portland, OR 97225
Phone (503) 216-1234

2700 NW Stewart Pkwy
Roseburg, OR 97471
Phone (541) 673-0611

1615 Delaware St
Longview, WA 98632
Phone (360) 363-4818

Organizations & group practices 12

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 3

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": "1119484800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1627257600000",
    "number": "1609872753",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 3158",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972083158"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9205 SW BARNES RD",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972256603",
            "telephone_number": "503-216-2906",
            "fax_number": "503-216-4114"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MOON",
        "first_name": "DAVID",
        "middle_name": "K.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-06-23",
        "last_updated": "2021-07-26",
        "certification_date": "2021-07-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "OR",
            "license": "MD23264",
            "primary": false
        },
        {
            "code": "208M00000X",
            "taxonomy_group": "",
            "desc": "Hospitalist",
            "state": "OR",
            "license": "MD23264",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "129981",
            "state": "OR"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "8233157",
            "state": "WA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RR MEDICARE",
            "identifier": "P00465304",
            "state": "OR"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Portland, OR

Sources for this page

Verify at the official NPI Registry.