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Recently Updated NPI Information — some details in this NPI profile have been updated in the NPI registry within the last 60 days.

MR. SONG JUN MOON PA-C
NPI 1780019539
Physician Assistant in San Antonio, TX

Active since September 12, 2013PECOS Enrolled
11207 WILD PNE STE 103, SAN ANTONIO, TX 78253(210) 201-1603(210) 202-5035 Get Directions Write a Review

NPPES record last updated: October 19, 2026. Verified against the NPPES registry weekly; last sync: October 25, 2026.

Record update history: Dec 17, 2024, Nov 6, 2020, May 23, 2018 (3 updates tracked since 2018).

About Mr. Song Jun Moon Pa-c NPPES

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

MR. SONG JUN MOON PA-C (NPI 1780019539) is an individual physician assistant in San Antonio, Texas, licensed in Texas (PA18550) and active in the NPI registry since September 2013. He is enrolled in Medicare PECOS and is a graduate of Other (2014).

NPPES Registry Identity

NPI1780019539
Entity TypeIndividualMale
Primary Taxonomy363A00000X
Provider Legal NameMR. SONG JUN MOONCredential: PA-C
Location Address11207 WILD PNE STE 103San Antonio, TX 78253-7293
Mailing Address11207 Wild Pne Ste 103San Antonio, TX 78253-7293 · (210) 201-1603 · Fax (210) 202-5035
Phone(210) 201-1603
Fax(210) 202-5035
Sole ProprietorNo
Medical School CMSOtherGraduated 2014
Enumeration DateSeptember 12, 2013
Last NPPES UpdateOctober 19, 20263 updates tracked since enumeration
NPPES CertifiedOctober 19, 2026
✔ NPI 1780019539 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyPhysician AssistantPhysician Assistants & Advanced Practice Nursing Providers
Taxonomy Code363A00000X
License✔ Licensed in TX · PA18550
Definition
A physician assistant is a person who has successfully completed an accredited education program for physician assistant, is licensed by the state and is practicing within the scope of that license. Physician assistants are formally trained to perform many of the routine, time-consuming tasks a physician can do. In some states, they may prescribe medications. They take medical histories, perform physical exams, order lab tests and x-rays, and give inoculations. Most states require that they work under the supervision of a physician.
11207 WILD PNE STE 103, San Antonio, TX 78253
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Accepted Insurance

The full list of accepted plans is on the Insurance tab. Issuers include Ambetter from Arizona Complete Health, Ambetter from Arkansas Health & Wellness, Ambetter from Louisiana Healthcare Connections and more.Insurance ›

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

Mr. Song Jun Moon Pa-c 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 ID9436661485
PECOS Enrollment IDI20250625000934
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.

Physician Visit Costs CMS claims · ZIP area

Typical Medicare office-visit costs in the 78253 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
$68.55 typical visit price
range $17.52 – $136.11
Typical copayment $17.13 (range $4.38 – $34.02)
Most-billed visit code 99213
Amounts reflect what Medicare beneficiaries in this ZIP area are typically charged for office visits. Patients with other coverage should check their individual plans.

Other Providers at the Same Location NPPES 2

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

ANNA SABRINA AYALA LPC
Counselor (Professional)
11207 WILD PNE STE 103
SAN ANTONIO, TX 78253
Bexar County (512) 645-1853
MR. RODNEY A HO JR. PHYSICIAN ASSISTANT
Physician Assistant
11207 WILD PNE STE 103
SAN ANTONIO, TX 78253
Bexar County (210) 201-1603

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 Song Moon's NPI number?

The NPI number for Song Moon is 1780019539. It was assigned to this individual provider in the NPPES registry on September 12, 2013.

Where is Song Moon located?

Song Moon practices at 11207 Wild Pne Ste 103, San Antonio, TX 78253. The listed phone number is (210) 201-1603.

What is Song Moon's specialty?

The primary specialty registered for this NPI is Physician Assistant with taxonomy code 363A00000X.

Is Song Moon enrolled in Medicare?

Yes. Song 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.

What insurance does Song Moon accept?

Health plans from Ambetter Health, Ambetter from Arizona Complete Health, Ambetter from Arkansas Health & Wellness, Ambetter from Louisiana Healthcare Connections and Ambetter from Superior HealthPlan and 5 other insurers list Song 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 Song Moon was last updated on October 19, 2026. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 8 days 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.