JI SOO MOON AG-ACNP
NPI 1043804255
Nurse Practitioner - Acute Care in Forest Hills, NY
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, maintains a secondary practice location in Worcester, and is a graduate of University Of Massachusetts Medical School (2020).
NPPES Registry Identity
Specialties & Licenses
Secondary Practice Location 1
Accepted Insurance
Medicare Participation & PECOS CMS
Medicare enrollment, assignment, billing reassignment, and ordering and referring status from CMS.
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.
Medicare Billing Reassignments
3Medicare enrollment records show Ji Soo Moon reassigns Medicare billing to 3 organizations. Each organization bills Medicare for the services this provider delivers there; the nearest is listed first.
New Hyde Park, NY 11040
- Reassigned Medicare billing, New York enrollment
- 9,353 clinicians in this Medicare group
Stony Brook, NY 11790
- Reassigned Medicare billing, New York enrollment
Boynton Beach, FL 33426
- Reassigned Medicare billing, New York enrollment
- 2,450 clinicians in this Medicare group
Source: CMS Revalidation Reassignment List, October 2026 release. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.
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.
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.
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.
FOREST HILLS, NY 11375
FOREST HILLS, NY 11375
FOREST HILLS, NY 11375
FOREST HILLS, NY 11375
FOREST HILLS, NY 11375
FOREST HILLS, NY 11375
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.
Which organizations bill Medicare for Ji Soo Moon's services?
According to the CMS Revalidation Reassignment List (October 2026 release), Ji Soo Moon reassigns Medicare benefits to 3 organizations: North Shore - Lij Medical PC (New Hyde Park, NY), Jsm Wellness Np In Acute Care P.C. (Stony Brook, NY) and New York University (Boynton Beach, FL). Each reassignment is filed with Medicare on form CMS-855R, signed by both the clinician and the organization, and lets the organization bill Medicare and receive payment for Ji Soo Moon's services. Reassignment records can lag staffing changes; confirm current arrangements with the organization.
What insurance does Ji Soo Moon accept?
Health plans from Taro Health list Ji Soo Moon as in-network in at least one marketplace plan. Coverage varies by plan and year; verify with the insurer or the provider before a visit.
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.
# Ji Soo Moon, AG-ACNP · NPI 1043804255
Acute Care physician in Forest Hills, New York. Individual provider, active in the CMS NPPES registry since February 28, 2021.
## Identity
- **NPI:** 1043804255 (Entity type: Individual)
- **Enumerated:** February 28, 2021
- **Primary specialty:** Nurse Practitioner - Acute Care · taxonomy 363LA2100X
- **State license:** F432459-01 (New York)
- **Sole proprietor:** No
## Practice location
- **Address:** 10201 66TH RD, Forest Hills, NY 11375-2029
- **Phone:** (718) 830-4000
## Medicare
- **Medicare:** Enrolled (PECOS); accepts Medicare assignment
- **Ordering & referring:** eligible for Part B labs & imaging, durable medical equipment, home health, power mobility devices
- **Bills Medicare through:** 3 organizations under Medicare reassignment (form CMS-855R): North Shore - Lij Medical PC (NPI 1790043479, New Hyde Park, NY); Jsm Wellness Np In Acute Care P.C. (NPI 1255137592, Stony Brook, NY); New York University (NPI 1285826438, Boynton Beach, FL) · CMS Revalidation Reassignment List, October 2026 release
- **Medical school:** University Of Massachusetts Medical School, class of 2020
## Record status
- **NPPES last updated:** July 13, 2023
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Source: [NPI Profile](https://npiprofile.com/npi/1043804255) · Data from the CMS NPPES public registry.