Individual provider Active NPI

Andrew Moon, MD

  • Anesthesiology Physician
  • Oakland, CA
National Provider Identifier
1609882133
Registry record updated Dec 11, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Anesthesiology PhysicianTaxonomy code 207L00000X
License
A65483 Issued in CA
Practice address
3875 Telegraph Ave
Oakland, CA 94609-2428
Phone
(510) 547-2244
NPI assigned
Aug 1, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 11, 2018

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Anesthesiology Physician 207L00000X A65483 CA Primary

Addresses

Primary practice location

3875 Telegraph Ave
Oakland, CA 94609-2428

Mailing address

PO Box 398398
San Francisco, CA 94139-8398
Phone (888) 991-1101

Other identifiers 1

IdentifierTypeStateIssuer
00A654830MedicaidCA

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA
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
I20040930000605 CA Practitioner - Anesthesiology 9133198666 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Anesthesiology
Education
University of Michigan Medical School, 1996
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Ambulatory Consultants Medical Group IncGroup PAC ID 0446299184, 6 clinicians

Practice addresses (Care Compare)

3875 Telegraph Ave
Oakland, CA 94609-2428
Phone (510) 547-2244

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Ambulatory Consultants Medical Group Inc Anesthesiology CurrentSince Jul 1, 2013 Accepting new patients
East Bay Anesthesiology Medical Group, Inc Anesthesiology Past Accepting new patients

Locations

3875 Telegraph Ave
Oakland, CA 94609
Phone (510) 547-2244

Organizations & group practices 2

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": "1154390400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1544486400000",
    "number": "1609882133",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 398398",
            "city": "SAN FRANCISCO",
            "state": "CA",
            "postal_code": "941398398",
            "telephone_number": "888-991-1101",
            "fax_number": "903-787-5854"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3875 TELEGRAPH AVE",
            "city": "OAKLAND",
            "state": "CA",
            "postal_code": "946092428",
            "telephone_number": "510-547-2244"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MOON",
        "first_name": "ANDREW",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-08-01",
        "last_updated": "2018-12-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207L00000X",
            "taxonomy_group": "",
            "desc": "Anesthesiology",
            "state": "CA",
            "license": "A65483",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00A654830",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Oakland, CA

Sources for this page

Verify at the official NPI Registry.