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MOON FAMILY & BEHAVIORAL HEALTH LLC
NPI 1902512122
Family Medicine in Pickerington, OH

Active since January 31, 2023CLIA 36D2273720 · Waiver
161 CLINT DR STE 200, PICKERINGTON, OH 43147(614) 705-6161(614) 705-6151 Get Directions Write a Review

NPPES record last updated: January 31, 2023. Verified against the NPPES registry weekly; last sync: October 18, 2026.

About Moon Family & Behavioral Health Llc NPPES

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

MOON FAMILY & BEHAVIORAL HEALTH LLC (NPI 1902512122) is a healthcare organization registered as a family medicine in Pickerington, Ohio and active in the NPI registry since January 2023. The organization holds a CLIA Waiver certificate valid through December 18, 2026 and lists Brian Dean, Admin, as its authorized official.

NPPES Registry Identity

NPI1902512122
Entity TypeOrganization
Primary Taxonomy207Q00000X
Legal Business NameMOON FAMILY & BEHAVIORAL HEALTH LLC
Location Address161 CLINT DR STE 200Pickerington, OH 43147-7794
Mailing Address161 Clint Dr Ste 200Pickerington, OH 43147-7794 · (614) 705-6161 · Fax (614) 705-6151
Phone(614) 705-6161
Fax(614) 705-6151
Organization SubpartNo
Authorized OfficialBrian DeanAdmin · (614) 706-5206
Enumeration DateJanuary 31, 2023
NPPES CertifiedJanuary 31, 2023
✔ NPI 1902512122 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 2

★ Primary SpecialtyFamily MedicineAllopathic & Osteopathic Physicians
Taxonomy Code207Q00000X
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.
Also ListedFamily Medicine · Addiction MedicineTaxonomy 207QA0401X
161 CLINT DR STE 200, Pickerington, OH 43147
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Group Practice 1

Group TaxonomyThis provider is a business group of one or more individual practitioners, who practice with different areas of specialization.193200000X MULTI-SPECIALTY GROUP

Accepted Insurance

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

Medicare Participation & PECOS CMS

Medicare enrollment and the clinicians who bill Medicare through this organization, from CMS.

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Moon Family & Behavioral Health Llc is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

Clinicians Billing Medicare Through This Organization

2

Medicare enrollment records show 2 clinicians reassign Medicare billing to Moon Family & Behavioral Health LLC, which bills Medicare for the services they deliver. Of these, 1 practice at this address. They are listed nearest first.

Clinicians, nearest first (2)

Mamadou Diallo, DNP, FNP-BC,PMHNP-BC
Nurse Practitioner
NPI 1922594746
161 CLINT DR STE 200
Pickerington, OH 43147
(614) 705-6161
✔ PECOS✔ Accepts MedicareSame address
Ebrima Jatta, ARNP
Nurse Practitioner
NPI 1205134210
4526 FEDERAL AVE
Everett, WA 98203
(425) 249-2530
✔ PECOS2,020 mi

Source: CMS Revalidation Reassignment List, October 2026 release. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.

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 36D2273720

Moon Family & Behavioral Health LLC · Pickerington, OH
Active · expires Dec 18, 2026
CLIA Number36D2273720
Laboratory TypePhysician Office
Certificate Effective DateDecember 19, 2024
Certificate Expiration DateDecember 18, 2026
Laboratory DirectorMamadou S. Diallo
Laboratory Phone(614) 354-1295
Laboratory LocationMoon Family & Behavioral Health LLC161 Clint Drive, Suite 200, Pickerington, OH 43147
CLIA data matches this NPI record on: Address Name
This certificate is issued to a laboratory to perform only waived tests.

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 Moon Family & Behavioral Health LLC's NPI number?

The NPI number for Moon Family & Behavioral Health LLC is 1902512122. It was assigned to this organization in the NPPES registry on January 31, 2023.

Where is Moon Family & Behavioral Health LLC located?

Moon Family & Behavioral Health LLC is located at 161 Clint Dr Ste 200, Pickerington, OH 43147. The listed phone number is (614) 705-6161.

What is Moon Family & Behavioral Health LLC's specialty?

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

Is Moon Family & Behavioral Health LLC enrolled in Medicare?

Yes. Moon Family & Behavioral Health LLC is registered in the Medicare PECOS enrollment system.

How many clinicians bill Medicare through Moon Family & Behavioral Health LLC?

According to the CMS Revalidation Reassignment List (October 2026 release), 2 clinicians, all in Nurse Practitioner, reassign their Medicare billing to Moon Family & Behavioral Health 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. Of these, 1 practice at this address. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.

Does Moon Family & Behavioral Health LLC hold a CLIA laboratory certificate?

Yes. A Certificate of Waiver (number 36D2273720) is associated with this NPI, valid through December 18, 2026. CLIA certificates authorize laboratory testing under the federal Clinical Laboratory Improvement Amendments program.

What insurance does Moon Family & Behavioral Health LLC accept?

Health plans from Anthem Blue Cross and Blue Shield and Molina Healthcare list Moon Family & Behavioral Health LLC 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 Moon Family & Behavioral Health LLC was last updated on January 31, 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.