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JI SOO MOON AG-ACNP
NPI 1043804255
Nurse Practitioner - Acute Care in Forest Hills, NY

Active since February 28, 2021PECOS EnrolledAccepts Medicare Assignment
97.02/100
CMS Quality Rating
10201 66TH RD, FOREST HILLS, NY 11375(718) 830-4000 Get Directions Write a Review

NPPES record last updated: July 13, 2023. Verified against the NPPES registry weekly; last sync: August 09, 2026.

Record update history: Jul 13, 2023, Jun 17, 2021, Feb 28, 2021 (3 updates tracked since 2021).

About Ji Soo Moon Ag-acnp NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

JI SOO MOON AG-ACNP (NPI 1043804255) is an individual acute care provider in Forest Hills, New York, licensed in New York (F432459-01) and active in the NPI registry since February 2021. She is enrolled in Medicare PECOS, is affiliated with Northwell Hospital Glen Cove, and maintains a secondary practice location in Worcester.

NPPES Registry Identity

NPI1043804255
Entity TypeIndividualFemale
Primary Taxonomy363LA2100X
Provider Legal NameJI SOO MOONCredential: AG-ACNP
Location Address10201 66TH RDForest Hills, NY 11375-2029
Mailing Address55 Lake Ave NWorcester, MA 01655-0002 · (508) 334-1000
Phone(718) 830-4000
Sole ProprietorNo
Medical School CMSUniversity Of Massachusetts Medical SchoolGraduated 2020
Enumeration DateFebruary 28, 2021
Last NPPES UpdateJuly 13, 20233 updates tracked since enumeration
NPPES CertifiedJuly 13, 2023
✔ NPI 1043804255 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyNurse Practitioner · Acute CarePhysician Assistants & Advanced Practice Nursing Providers
Taxonomy Code363LA2100X
Licenses✔ Licensed in NY · F432459-01✔ Licensed in MA · RN2324806
10201 66TH RD, Forest Hills, NY 11375
Open in Google Maps ↗

Secondary Practice Location 1

Location 155 Lake Ave NWorcester, MA 01655-0002 · Phone (508) 334-1000

Medicare Participation & PECOS CMS

Medicare enrollment, assignment, and ordering and referring status from the CMS PECOS system.

Medicare Enrollment Status

✔

Enrolled in Medicare and accepts Medicare assignment

Ji Soo Moon Ag-acnp is registered in PECOS and agrees to accept the Medicare-approved amount as full payment. Medicare patients are not billed beyond the standard deductible and coinsurance.

PECOS PAC ID4284034943
PECOS Enrollment IDI20240220003841
Eligible to Order & Refer✔ Part B Labs & Imaging✔ Durable Medical Equipment✔ Home Health Agency✔ Power Mobility DevicesPer the CMS Ordering and Referring file. Eligibility means Medicare pays claims that this provider orders or refers for these categories.

Hospital Affiliations CMS Care Compare

Hospitals where this provider delivers care, identified from recent Medicare claims and place-of-service records.

Northwell Hospital Glen Cove

Acute Care Hospitals · Glen Cove, NY
5/5 CMS rating
OwnershipVoluntary non-profit - Private
CMS Certification Number330181
Location101 St Andrews LaneGlen Cove, NY 11542 · Nassau County
Emergency services

Physician Visit Costs CMS claims · ZIP area

Typical Medicare office-visit costs in the 11375 ZIP code area, from fee-for-service claims. These are area statistics, not this provider’s prices; actual charges vary by service and coverage.

New Patient
$104.17 typical visit price
range $67.00 – $201.98
Typical copayment $26.04 (range $16.75 – $50.49)
Most-billed visit code 99203
Established Patient
$116.96 typical visit price
range $21.62 – $163.52
Typical copayment $29.24 (range $5.40 – $40.88)
Most-billed visit code 99214
Amounts reflect what Medicare beneficiaries in this ZIP area are typically charged for office visits. Patients with other coverage should check their individual plans.

Medicare Quality Performance CMS QPP · MIPS

Performance in the CMS Quality Payment Program: the MIPS final score across four weighted categories, and the individual quality measures reported to Medicare.

97.02/100
MIPS Final ScoreMerit-based Incentive Payment System · CMS Quality Payment Program
Scored through an Alternative Payment Model
Quality78.09
Promoting Interoperability100
Improvement Activities40

Other Providers at the Same Location NPPES 20

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

SRAVYA REDDY MUNDLA
Student in an Organized Health Care Education/Training Program
10201 66TH RD
FOREST HILLS, NY 11375
Queens County (718) 830-4352
MR. SHIVNATHAN PILLAI SA
Specialist
10201 66TH RD
FOREST HILLS, NY 11375
Queens County (718) 830-4000
DR. JOHN DEPETRILLO JR. M.D.
Internal Medicine (Critical Care Medicine)
10201 66TH RD
FOREST HILLS, NY 11375
Queens County (718) 830-4359
XIN YUN LI MD
Surgery (Vascular Surgery)
10201 66TH RD
FOREST HILLS, NY 11375
Queens County (718) 830-4093
FARHAD MOHAMMAD GAZI MD
Emergency Medicine
10201 66TH RD, MEDICAL STAFF OFFICE
FOREST HILLS, NY 11375
Queens County (718) 830-4200
ANDREA ROMMAL
Student in an Organized Health Care Education/Training Program
10201 66TH RD
FOREST HILLS, NY 11375
Queens County (718) 830-4352
MARK WANIS DO
Student in an Organized Health Care Education/Training Program
10201 66TH RD
FOREST HILLS, NY 11375
Queens County (718) 830-4352
DR. PAUL SOLODNIK M.D.
Radiology (Diagnostic Radiology)
10201 66TH RD, RADIOLOGY DEPARTMENT
FOREST HILLS, NY 11375
Queens County (952) 595-1100

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Ji Soo Moon's NPI number?

The NPI number for Ji Soo Moon is 1043804255. It was assigned to this individual provider in the NPPES registry on February 28, 2021.

Where is Ji Soo Moon located?

Ji Soo Moon practices at 10201 66th Rd, Forest Hills, NY 11375. The listed phone number is (718) 830-4000.

What is Ji Soo Moon's specialty?

The primary specialty registered for this NPI is Nurse Practitioner, specializing in Acute Care, with taxonomy code 363LA2100X.

Is Ji Soo Moon enrolled in Medicare?

Yes. Ji Soo Moon is registered in the Medicare PECOS system and accepts Medicare assignment, which means accepting the Medicare-approved amount as payment in full for covered services.

Is Ji Soo Moon affiliated with any hospitals?

According to CMS data, Ji Soo Moon is affiliated with Northwell Hospital Glen Cove.

When was this NPI record last updated?

The NPPES record for Ji Soo Moon was last updated on July 13, 2023. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 3 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.