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DR. KELLEY E MOON M.D.
NPI 1255366035
Family Medicine in Nacogdoches, TX

Active since July 11, 2006Opted out of Medicare · through Jul 1, 2027CLIA 45D1003488 · Waiver
1320 N UNIVERSITY DR STE B, NACOGDOCHES, TX 75961(936) 559-9225(936) 559-9701 Get Directions Write a Review

NPPES record last updated: January 21, 2026. Verified against the NPPES registry weekly; last sync: August 16, 2026.

Record update history: Jan 21, 2026, Jun 18, 2025 (2 updates tracked since 2025).

About Dr. Kelley E Moon M.d. NPPES

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

DR. KELLEY E MOON M.D. (NPI 1255366035) is an individual family medicine provider in Nacogdoches, Texas, licensed in Texas (L4067) and active in the NPI registry since July 2006. She has opted out of Medicare through July 1, 2027 and remains eligible to order and refer and holds a CLIA Waiver certificate valid through February 18, 2027.

NPPES Registry Identity

NPI1255366035
Entity TypeIndividualFemale
Primary Taxonomy207Q00000X
Provider Legal NameDR. KELLEY E MOONCredential: M.D.
Location Address1320 N UNIVERSITY DR STE BNacogdoches, TX 75961-4270
Mailing Address1320 N University Dr Ste BNacogdoches, TX 75961-4270 · (936) 559-9225 · Fax (936) 559-9701
Phone(936) 559-9225
Fax(936) 559-9701
Sole ProprietorYes
Enumeration DateJuly 11, 2006
Last NPPES UpdateJanuary 21, 20262 updates tracked since enumeration
NPPES CertifiedJanuary 21, 2026
✔ NPI 1255366035 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyFamily MedicineAllopathic & Osteopathic Physicians
Taxonomy Code207Q00000X
License✔ Licensed in TX · L4067
Definition
Family Medicine is the medical specialty which is concerned with the total health care of the individual and the family. It is the specialty in breadth which integrates the biological, clinical, and behavioral sciences. The scope of family medicine is not limited by age, sex, organ system, or disease entity.
1320 N UNIVERSITY DR STE B, Nacogdoches, TX 75961
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Group Practice 1

Group TaxonomyThis provdier is a business group of one or more individual practitioners, all of who practice with the same area of specialization.193400000X SINGLE SPECIALTY GROUP

Accepted Insurance

The full list of accepted plans is on the Insurance tab. Issuers include UnitedHealthcare.Insurance ›

Medicare Participation & PECOS CMS

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

Medicare Enrollment Status

ⓘ

Opted out of Medicare

Dr. Kelley E Moon M.d. has filed a Medicare opt-out affidavit. Services are provided under private contract between the provider and the patient, and are not billed to or reimbursed by Medicare. The opt-out is on file from July 1, 2013 through July 1, 2027.

Opt-Out Effective DateJuly 1, 2013
Opt-Out In Effect ThroughJuly 1, 2027Opt-out affidavits renew automatically every two years unless cancelled
Eligible to Order & Refer✔ Part B Labs & Imaging✔ Durable Medical Equipment✔ Home Health Agency✔ Power Mobility DevicesAn opted-out provider can still order and refer for Medicare patients in the categories marked above, even though their own services are not covered.

CLIA Laboratory Certificates CMS CLIA

Laboratory certificates issued under the Clinical Laboratory Improvement Amendments (CLIA) program, which sets federal quality standards for human laboratory testing in the United States. There is no official CMS crosswalk between CLIA and NPI numbers; these certificates are associated with this NPI by matching facility names, locations and phone numbers in the CMS CLIA registry.

Certificate of Waiver 45D1003488

Kelley Moon, MD · Nacogdoches, TX
Active · expires Feb 18, 2027
CLIA Number45D1003488
Laboratory TypePhysician Office
Certificate Effective DateFebruary 19, 2025
Certificate Expiration DateFebruary 18, 2027
Laboratory DirectorKelley E. Moon
Laboratory Phone(936) 559-9225
Laboratory LocationKelley Moon, MD1320 North University Ste B, Nacogdoches, TX 75961
CLIA data matches this NPI record on: Name Phone
This certificate is issued to a laboratory to perform only waived tests.

Physician Visit Costs CMS claims · ZIP area

Typical Medicare office-visit costs in the 75961 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
$84.92 typical visit price
range $54.84 – $166.88
Typical copayment $21.23 (range $13.71 – $41.72)
Most-billed visit code 99203
Established Patient
$97.05 typical visit price
range $17.52 – $136.11
Typical copayment $24.26 (range $4.38 – $34.02)
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.

Referred Medical Equipment & Supplies CMS DME claims 5

Durable medical equipment, devices and supplies this provider ordered from DME suppliers for patients, from Medicare fee-for-service claims.

Filter, disposable, used with positive airway pressure device A7038
DME-Other DME · category DE001N
3 suppliers13 claims65 services$2.81 avg. paid by Medicare
Continuous positive airway pressure (cpap) device E0601
DME-Other DME · category DE001N
1 supplier12 claims12 services$53.72 avg. paid by Medicare
Budesonide, inhalation solution, fda-approved final product, non-compounded, administered through dme, unit dose form, up to 0.5 mg J7626
DME-Drugs Administered Through DME · category DG000N
1 supplier11 claims660 services$0.67 avg. paid by Medicare
Supply allowance for therapeutic continuous glucose monitor (cgm), includes all supplies and accessories, 1 month supply = 1 unit of service K0553
DME-Other DME · category DE017N
2 suppliers13 claims13 services$213.21 avg. paid by Medicare
Pharmacy dispensing fee for inhalation drug(s); per 30 days Q0513
DME-Other DME · category DE000N
1 supplier11 claims11 services$21.31 avg. paid by Medicare
Dollar amounts are the average Medicare paid the supplier per service. They are not the cost to the patient.

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 Kelley Moon's NPI number?

The NPI number for Kelley Moon is 1255366035. It was assigned to this individual provider in the NPPES registry on July 11, 2006.

Where is Kelley Moon located?

Kelley Moon practices at 1320 N University Dr Ste B, Nacogdoches, TX 75961. The listed phone number is (936) 559-9225.

What is Kelley Moon's specialty?

The primary specialty registered for this NPI is Family Medicine with taxonomy code 207Q00000X.

Is Kelley Moon enrolled in Medicare?

No. Kelley Moon has opted out of Medicare through July 1, 2027. Care is provided under private contracts, and Medicare does not pay for services furnished by providers who have opted out. The provider remains eligible to order and refer services for Medicare patients.

Does Kelley Moon hold a CLIA laboratory certificate?

Yes. A Certificate of Waiver (number 45D1003488) is associated with this NPI, valid through February 18, 2027. CLIA certificates authorize laboratory testing under the federal Clinical Laboratory Improvement Amendments program.

What insurance does Kelley Moon accept?

Health plans from UnitedHealthcare list Kelley 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 Kelley Moon was last updated on January 21, 2026. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 7 months 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.