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SANDRA MOON
NPI 1689059016
Nurse Practitioner - Pediatrics in Los Angeles, CA

Active since July 27, 2015PECOS Enrolled
3810 WILSHIRE BLVD APT 2211, #2211, LOS ANGELES, CA 90010(310) 729-7785 Get Directions Write a Review

NPPES record last updated: February 10, 2022. Verified against the NPPES registry weekly; last sync: October 18, 2026.

Record update history: Feb 10, 2022, Dec 8, 2021 (2 updates tracked since 2021).

About Sandra Moon NPPES

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

SANDRA MOON (NPI 1689059016) is an individual pediatrics provider in Los Angeles, California, licensed in California (95001140) and active in the NPI registry since July 2015. She is enrolled in Medicare PECOS.

NPPES Registry Identity

NPI1689059016
Entity TypeIndividualFemale
Primary Taxonomy363LP0200X
Provider Legal NameSANDRA MOON
Location Address3810 WILSHIRE BLVD APT 2211, #2211Los Angeles, CA 90010-3230
Mailing Address3810 Wilshire Blvd Apt 2211, #2211Los Angeles, CA 90010-3230
Phone(310) 729-7785
Sole ProprietorNo
Enumeration DateJuly 27, 2015
Last NPPES UpdateFebruary 10, 20222 updates tracked since enumeration
✔ NPI 1689059016 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyNurse Practitioner · PediatricsPhysician Assistants & Advanced Practice Nursing Providers
Taxonomy Code363LP0200X
License✔ Licensed in CA · 95001140
3810 WILSHIRE BLVD APT 2211, Los Angeles, CA 90010
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Medicare Participation & PECOS CMS

Medicare enrollment, assignment, billing reassignment, and ordering and referring status from CMS.

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Sandra Moon is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

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.

Medicare Billing Reassignment

Medicare enrollment records show Sandra Moon reassigns Medicare billing to 1 organization. The organization bills Medicare for the services this provider delivers there.

Southern California Permanente Medical Group
2.7 mi
Health Maintenance Organization
4760 W SUNSET BLVD
Los Angeles, CA 90027
  • Reassigned Medicare billing, California enrollment
  • 13,921 clinicians in this Medicare group
NPI 1134151657 (323) 783-4011

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 90010 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
$96.36 typical visit price
range $62.96 – $187.60
Typical copayment $24.09 (range $15.74 – $46.90)
Most-billed visit code 99203
Established Patient
$109.96 typical visit price
range $20.84 – $153.61
Typical copayment $27.49 (range $5.21 – $38.40)
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.

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 Sandra Moon's NPI number?

The NPI number for Sandra Moon is 1689059016. It was assigned to this individual provider in the NPPES registry on July 27, 2015.

Where is Sandra Moon located?

Sandra Moon practices at 3810 Wilshire Blvd Apt 2211 #2211, Los Angeles, CA 90010. The listed phone number is (310) 729-7785.

What is Sandra Moon's specialty?

The primary specialty registered for this NPI is Nurse Practitioner, specializing in Pediatrics, with taxonomy code 363LP0200X.

Is Sandra Moon enrolled in Medicare?

Yes. Sandra Moon is registered in the Medicare PECOS enrollment system.

Which organization bills Medicare for Sandra Moon's services?

According to the CMS Revalidation Reassignment List (October 2026 release), Sandra Moon reassigns Medicare benefits to Southern California Permanente Medical Group (Los Angeles, CA). The 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 Sandra Moon's services. Reassignment records can lag staffing changes; confirm current arrangements with the organization.

When was this NPI record last updated?

The NPPES record for Sandra Moon was last updated on February 10, 2022. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 4 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.