KENNETH TAEHO MOON M.D.
NPI 1972591345
Family Medicine in Hollywood, MD

Q: What is Kenneth Moon's NPI number?

The NPI number for Kenneth Moon is 1972591345. It was assigned to this individual provider in the NPPES registry on October 11, 2005.

Q: What is Kenneth Moon's specialty?

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

Q: When was this NPI record last updated?

The NPPES record for Kenneth Moon was last updated on October 24, 2025. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 12 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.

Active since October 11, 2005PECOS Enrolled

24435 MERVELL DEAN RD, HOLLYWOOD, MD 20636(301) 373-2116 Get Directions Write a Review

NPPES record last updated: October 24, 2025. Verified against the NPPES registry weekly; last sync: October 25, 2026.

On this page

About Kenneth Taeho Moon M.d. NPPES

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

KENNETH TAEHO MOON M.D. (NPI 1972591345) is an individual family medicine provider in Hollywood, Maryland, licensed in Maryland (D0057219) and active in the NPI registry since October 2005. He is enrolled in Medicare PECOS.

NPPES Registry Identity

NPI1972591345

Entity TypeIndividualMale

Primary Taxonomy207Q00000X

Provider Legal NameKENNETH TAEHO MOONCredential: M.D.

Location Address24435 MERVELL DEAN RDHollywood, MD 20636-2712

Mailing AddressPo Box 37Hollywood, MD 20636-0037 · (301) 373-2116

Phone(301) 373-2116

Sole ProprietorNo

Enumeration DateOctober 11, 2005

Last NPPES UpdateOctober 24, 2025

NPPES CertifiedOctober 24, 2025

✔ NPI 1972591345 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyFamily MedicineAllopathic & Osteopathic Physicians

Taxonomy Code207Q00000X

Licenses✔ Licensed in MD · D0057219✔ Licensed in DC · 32929

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.

24435 MERVELL DEAN RD, Hollywood, MD 20636

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Other Identifiers 1

Other080185963DC · Medicare Rr

Medicare Participation & PECOS CMS

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

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Kenneth Taeho Moon M.d. 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 Reassignments

Medicare enrollment records show Kenneth Moon reassigns Medicare billing to 3 organizations. Each organization bills Medicare for the services this provider delivers there; the nearest is listed first.

Medstar Medical Group II LLC

30 mi

General Practice

13950 BRANDYWINE RD, SUITE 225
Brandywine, MD 20613

Reassigned Medicare billing, District of Columbia enrollment
Medicare enrollment name: Mgmc LLC
861 clinicians in this Medicare group

NPI 1285064550 (301) 782-2220

Medstar Medical Group II LLC

47 mi

Internal Medicine

1145 19TH ST NW, SUITE 311
Washington, DC 20036

Reassigned Medicare billing, District of Columbia enrollment
3,530 clinicians in this Medicare group

NPI 1376887844 (202) 429-2401

Signify Health Medical Associates, PLLC

1,198 mi

General Practice

4055 VALLEY VIEW LN STE 700
Dallas, TX 75244

Reassigned Medicare billing, District of Columbia enrollment
75 clinicians in this Medicare group

NPI 1750845863 (972) 715-3800

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 20636 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

$89.75 typical visit price

range $57.99 – $175.57

Typical copayment $22.43 (range $14.49 – $43.89)

Most-billed visit code 99203

Established Patient

$102.11 typical visit price

range $18.66 – $143.02

Typical copayment $25.52 (range $4.66 – $35.75)

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.

Other Providers at the Same Location NPPES 3

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

YOUNGSIK MOON, M.D., P.A.

Family Medicine

24435 MERVELL DEAN RD
HOLLYWOOD, MD 20636

St. Mary's County (301) 373-2116

LAURA ZILBERMAN NP-C

Nurse Practitioner (Family)

24435 MERVELL DEAN RD
HOLLYWOOD, MD 20636

St. Mary's County (301) 373-2116

YOUNGSIK MOON, M.D., P.A.

Clinic/Center (Ambulatory Surgical)

24435 MERVELL DEAN RD
HOLLYWOOD, MD 20636

St. Mary's County (301) 373-2116

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 Kenneth Moon's NPI number?

The NPI number for Kenneth Moon is 1972591345. It was assigned to this individual provider in the NPPES registry on October 11, 2005.

Where is Kenneth Moon located?

Kenneth Moon practices at 24435 Mervell Dean Rd, Hollywood, MD 20636. The listed phone number is (301) 373-2116.

What is Kenneth Moon's specialty?

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

Is Kenneth Moon enrolled in Medicare?

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

Which organizations bill Medicare for Kenneth Moon's services?

According to the CMS Revalidation Reassignment List (October 2026 release), Kenneth Moon reassigns Medicare benefits to 3 organizations: Medstar Medical Group II LLC (Brandywine, MD), Medstar Medical Group II LLC (Washington, DC) and Signify Health Medical Associates, PLLC (Dallas, TX). Each 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 Kenneth 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 Kenneth Moon was last updated on October 24, 2025. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 12 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.