Individual provider Active NPI

Tyler James Moon, MD

  • Student in an Organized Health Care Education/Training Program
  • Houston, TX
National Provider Identifier
1871120741
Registry record updated Jun 24, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Student in an Organized Health Care Education/Training ProgramTaxonomy code 390200000X
Practice address
6431 Fannin St Ste JJL 310
Houston, TX 77030-1501
Phone
(314) 809-3938
NPI assigned
Mar 23, 2020
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 24, 2025

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Student in an Organized Health Care Education/Training Program 390200000X Primary

Addresses

Primary practice location

6431 Fannin St Ste JJL 310
Houston, TX 77030-1501

Mailing address

6431 Fannin St Ste JJL 310
Houston, TX 77030-1501

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OH
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
I20200511003221 OH Order and Referring Only - Orthopedic SurgeryPractitioner - Orthopedic Surgery 8224469002

Care Compare profile

Medicare Care Compare
Specialty
Orthopedic Surgery
Education
Washington University School of Medicine, 2020
Medicare assignment
May accept Medicare assignment

Practice addresses (Care Compare)

8170 33Rd Ave
Ms 21110Q
Bloomington, MN 55425-4516

8170 33Rd Ave S
Bloomington, MN 55425-1614

National Provider Directory

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

Interoperability endpoints

  • Direct secure messaging: tmoon31513@ehrdirect.uhhospitals.org

NPI Registry JSON

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

{
    "created_epoch": "1584921600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1750723200000",
    "number": "1871120741",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6431 FANNIN ST STE JJL 310",
            "city": "HOUSTON",
            "state": "TX",
            "postal_code": "770301501"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6431 FANNIN ST STE JJL 310",
            "city": "HOUSTON",
            "state": "TX",
            "postal_code": "770301501",
            "telephone_number": "314-809-3938"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MOON",
        "first_name": "TYLER",
        "middle_name": "JAMES",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2020-03-23",
        "last_updated": "2025-06-24",
        "certification_date": "2025-06-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Houston, TX

Sources for this page

Verify at the official NPI Registry.