MR. STACY JERALD MOON DDS
NPI 1881645166
Dentist in Boise, ID

Q: What is Stacy Moon's NPI number?

The NPI number for Stacy Moon is 1881645166. It was assigned to this individual provider in the NPPES registry on May 12, 2006.

Q: What is Stacy Moon's specialty?

The primary specialty registered for this NPI is Dentist with taxonomy code 122300000X.

Q: When was this NPI record last updated?

The NPPES record for Stacy Moon was last updated on July 6, 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.

Active since May 12, 2006PECOS Enrolled

4266 N EAGLE RD, BOISE, ID 83713(208) 939-7053(208) 938-6032 Get Directions Write a Review

NPPES record last updated: July 6, 2023. Verified against the NPPES registry weekly; last sync: August 16, 2026.

On this page

About Mr. Stacy Jerald Moon Dds NPPES

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

MR. STACY JERALD MOON DDS (NPI 1881645166) is an individual dentist in Boise, Idaho, licensed in Idaho (D3387) and active in the NPI registry since May 2006. He is enrolled in Medicare PECOS.

NPPES Registry Identity

NPI1881645166

Entity TypeIndividualMale

Primary Taxonomy122300000X

Provider Legal NameMR. STACY JERALD MOONCredential: DDS

Location Address4266 N EAGLE RDBoise, ID 83713-0726

Mailing Address3550 N Brookside LnBoise, ID 83714-9705 · (208) 908-1793

Phone(208) 939-7053

Fax(208) 938-6032

Sole ProprietorYes

Enumeration DateMay 12, 2006

Last NPPES UpdateJuly 6, 2023

NPPES CertifiedJuly 6, 2023

✔ NPI 1881645166 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyDentistDental Providers

Taxonomy Code122300000X

License✔ Licensed in ID · D3387

Definition

A dentist is a person qualified by a doctorate in dental surgery (D.D.S.) or dental medicine (D.M.D.), licensed by the state to practice dentistry, and practicing within the scope of that license. There is no difference between the two degrees: dentists who have a DMD or DDS have the same education. Universities have the prerogative to determine what degree is awarded. Both degrees use the same curriculum requirements set by the American Dental Association's Commission on Dental Accreditation. Generally, three or more years of undergraduate education plus four years of dental school is required to graduate and become a general dentist. State licensing boards accept either degree as equivalent, and both degrees allow licensed individuals to practice the same scope of general dentistry. Additional post-graduate training is required to become a dental specialist.

4266 N EAGLE RD, Boise, ID 83713

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Other Identifiers 1

Other820527796ID · Irs

Accepted Insurance

The full list of accepted plans is on the Insurance tab. Issuers include Anthem Blue Cross and Blue Shield.Insurance ›

Medicare Participation & PECOS CMS

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

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Mr. Stacy Jerald Moon Dds 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.

Physician Visit Costs CMS claims · ZIP area

Typical Medicare office-visit costs in the 83713 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

$81.13 typical visit price

range $52.44 – $160.17

Typical copayment $20.28 (range $13.11 – $40.04)

Most-billed visit code 99203

Established Patient

$65.77 typical visit price

range $16.68 – $130.93

Typical copayment $16.44 (range $4.17 – $32.73)

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

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

ZACHARY TAYLOR DDS PLLC

Clinic/Center (Dental)

4266 N EAGLE RD
BOISE, ID 83713

Ada County (208) 939-7053

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 Stacy Moon's NPI number?

The NPI number for Stacy Moon is 1881645166. It was assigned to this individual provider in the NPPES registry on May 12, 2006.

Where is Stacy Moon located?

Stacy Moon practices at 4266 N Eagle Rd, Boise, ID 83713. The listed phone number is (208) 939-7053.

What is Stacy Moon's specialty?

The primary specialty registered for this NPI is Dentist with taxonomy code 122300000X.

Is Stacy Moon enrolled in Medicare?

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

What insurance does Stacy Moon accept?

Health plans from Anthem Blue Cross and Blue Shield list Stacy 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 Stacy Moon was last updated on July 6, 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.