BLUE MOON THERAPY LLC
NPI 1205319472
Clinic/Center - Mental Health (Including Community Mental Health Center) in Wichita, KS
About Blue Moon Therapy Llc NPPES
Official registry information on file with the National Plan and Provider Enumeration System.
BLUE MOON THERAPY LLC (NPI 1205319472) is a healthcare organization registered as a mental health (including community mental health center) in Wichita, Kansas and active in the NPI registry since September 2018. The organization lists Shannon D. Goodwin, Clinical Social Worker, as its authorized official.
NPPES Registry Identity
Specialties & Licenses
Medicare Participation & PECOS CMS
Medicare enrollment and the clinicians who bill Medicare through this organization, from CMS.
Medicare Enrollment Status
Enrolled in Medicare (PECOS)
Blue Moon Therapy Llc is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).
Clinicians Billing Medicare Through This Organization
Medicare enrollment records show 1 clinician reassigns Medicare billing to Blue Moon Therapy LLC, which bills Medicare for the services this clinician delivers.
Clinician (1)
Source: CMS Revalidation Reassignment List, October 2026 release. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.
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 Blue Moon Therapy LLC's NPI number?
The NPI number for Blue Moon Therapy LLC is 1205319472. It was assigned to this organization in the NPPES registry on September 12, 2018.
Where is Blue Moon Therapy LLC located?
Blue Moon Therapy LLC is located at 400 N Woodlawn Suite 100, Wichita, KS 67216. The listed phone number is (316) 652-2580.
What is Blue Moon Therapy LLC's specialty?
The primary specialty registered for this NPI is Clinic/Center, specializing in Mental Health (Including Community Mental Health Center), with taxonomy code 261QM0801X.
Is Blue Moon Therapy LLC enrolled in Medicare?
Yes. Blue Moon Therapy LLC is registered in the Medicare PECOS enrollment system.
How many clinicians bill Medicare through Blue Moon Therapy LLC?
According to the CMS Revalidation Reassignment List (October 2026 release), 1 clinician (Clinical Social Worker) reassigns their Medicare billing to Blue Moon Therapy LLC. A 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 the clinician's services. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.
When was this NPI record last updated?
The NPPES record for Blue Moon Therapy LLC was last updated on September 12, 2018. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 8 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.
# Blue Moon Therapy Llc · NPI 1205319472
Mental Health (Including Community Mental Health Center) organization in Wichita, Kansas. Organization record, active in the CMS NPPES registry since September 12, 2018.
## Identity
- **NPI:** 1205319472 (Entity type: Organization)
- **Enumerated:** September 12, 2018
- **Primary specialty:** Clinic/Center - Mental Health (Including Community Mental Health Center) · taxonomy 261QM0801X
- **Organization subpart:** No
- **Authorized official:** Shannon Goodwin, CLINICAL SOCIAL WORKER
## Practice location
- **Address:** 400 N WOODLAWN, SUITE 100, Wichita, KS 67216-1360
- **Phone:** (316) 652-2580
## Medicare
- **Medicare:** Enrolled in Medicare (PECOS)
- **Clinicians billing through this organization:** 1 clinician (Clinical Social Worker) reassigns Medicare billing to this organization (form CMS-855R) · CMS Revalidation Reassignment List, October 2026 release
## Record status
- **NPPES last updated:** September 12, 2018
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Source: [NPI Profile](https://npiprofile.com/npi/1205319472) · Data from the CMS NPPES public registry.