MOONSHOT PSYCHIATRIC NURSE PRACTITIONER PC
MOONSHOT PSYCHIATRIC NURSE PRACTITIONER PC is an organization registered with the National Plan and Provider Enumeration System (NPPES) under NPI 1669158879, based in Seattle, WA. The organization lists 2 taxonomy classifications, with Psychiatric/Mental Health Nurse Practitioner recorded as primary.
Getting there
The practice address on file is 4803 FREMONT AVE N, Seattle, WA 98103. We have not yet mapped what surrounds this office — parking, transit, and nearby pharmacies are added as our data collection reaches each location.
Credentials and Medicare
NPPES does not list a state licence number for this record. That is not unusual — organizations and some provider types are not required to file one. Verify current licensure with the relevant state board before care.
- Status
- Approved
- Provider type
- Part B Supplier - Clinic/group Practice
- PAC ID
- 9335589696
Enrolled in Medicare 36 times, across 36 states:
| State | Enrollment ID | Provider type |
|---|---|---|
| Washington | O20240503000158 | Part B Supplier - Clinic/group Practice |
| New Jersey | O20240612000054 | Part B Supplier - Clinic/group Practice |
| Oregon | O20240725003945 | Part B Supplier - Clinic/group Practice |
| Florida | O20241028003481 | Part B Supplier - Clinic/group Practice |
| Massachusetts | O20250211000314 | Part B Supplier - Clinic/group Practice |
| Nevada | O20250307000759 | Part B Supplier - Clinic/group Practice |
| District of Columbia | O20250416000226 | Part B Supplier - Clinic/group Practice |
| Illinois | O20250416001499 | Part B Supplier - Clinic/group Practice |
| New Hampshire | O20250421000582 | Part B Supplier - Clinic/group Practice |
| Pennsylvania | O20250423000770 | Part B Supplier - Clinic/group Practice |
| Connecticut | O20250424000651 | Part B Supplier - Clinic/group Practice |
| South Carolina | O20250424002549 | Part B Supplier - Clinic/group Practice |
| Tennessee | O20250430000721 | Part B Supplier - Clinic/group Practice |
| North Carolina | O20250521001971 | Part B Supplier - Clinic/group Practice |
| Kentucky | O20250523002061 | Part B Supplier - Clinic/group Practice |
| Indiana | O20250610001425 | Part B Supplier - Clinic/group Practice |
| Georgia | O20250617002695 | Part B Supplier - Clinic/group Practice |
| West Virginia | O20250618000889 | Part B Supplier - Clinic/group Practice |
| Michigan | O20250621000029 | Part B Supplier - Clinic/group Practice |
| Ohio | O20250623003147 | Part B Supplier - Clinic/group Practice |
| Rhode Island | O20250707000052 | Part B Supplier - Clinic/group Practice |
| Maryland | O20250722002918 | Part B Supplier - Clinic/group Practice |
| Arizona | O20250724001437 | Part B Supplier - Clinic/group Practice |
| Mississippi | O20250730002255 | Part B Supplier - Clinic/group Practice |
| Maine | O20250820002399 | Part B Supplier - Clinic/group Practice |
| Vermont | O20250909003282 | Part B Supplier - Clinic/group Practice |
| Delaware | O20251028003854 | Part B Supplier - Clinic/group Practice |
| Iowa | O20251105000358 | Part B Supplier - Clinic/group Practice |
| Louisiana | O20251113003113 | Part B Supplier - Clinic/group Practice |
| Alaska | O20251120000310 | Part B Supplier - Clinic/group Practice |
| Colorado | O20251203002703 | Part B Supplier - Clinic/group Practice |
| Minnesota | O20251210001403 | Part B Supplier - Clinic/group Practice |
| New Mexico | O20251223000822 | Part B Supplier - Clinic/group Practice |
| Utah | O20260122001544 | Part B Supplier - Clinic/group Practice |
| Idaho | O20260226004036 | Part B Supplier - Clinic/group Practice |
| Hawaii | O20260227001492 | Part B Supplier - Clinic/group Practice |
Medicare enrolment is recorded as approved under the provider type Part B Supplier - Clinic/group Practice. There are 36 separate enrolment records across 36 states (WA, NJ, OR, FL, MA, NV, DC, IL, NH, PA, CT, SC, TN, NC, KY, IN, GA, WV, MI, OH, RI, MD, AZ, MS, ME, VT, DE, IA, LA, AK, CO, MN, NM, UT, ID, HI). Multiple enrolments usually mean the provider bills Medicare from more than one practice location, or has kept an earlier enrolment after moving. Each record carries its own enrolment ID, listed above. Being enrolled means the provider can bill Medicare; it does not tell you whether they are currently accepting new Medicare patients. Call the office to confirm.
What Psychiatric/Mental Health covers
Definition to come... NUCC Health Care Provider Taxonomy, code 363LP0808X
All registered taxonomy codes
This provider registers 2 taxonomy codes. The primary code is what appears on most claims; the others record additional recognised specialties.
| Code | Specialty | Licence | State | |
|---|---|---|---|---|
| 363LP0808X | Psychiatric/Mental Health Nurse Practitioner Psychiatric/Mental Health | — | — | primary |
| 363LF0000X | Family Nurse Practitioner Family | — | — |
The taxonomy records how the provider classifies their own practice. It does not confirm which conditions they currently treat, whether they are accepting new patients, or which insurance they take — call the office for that.
Full NPPES record
An NPI-2 identifies an organization — a clinic, hospital, group practice, laboratory, or supplier. Individual clinicians working there hold their own NPI-1 numbers separately, so a bill may reference both.
| NPI | 1669158879 valid check digit |
|---|---|
| Entity type | Organization (NPI-2) |
| Enumeration date | Jun 22, 2023 |
| Last updated | Nov 26, 2025 |
| Status | Active |
| Practice address |
4803 FREMONT AVE N Seattle, WA 98103 (855) 444-7258 |
| Mailing address |
22406 68TH AVE W Mountlake Terrace, WA 98043 |
Number check
How the check works, step by step
Every NPI carries a Luhn check digit — the same scheme used on credit cards. CMS prefixes the number with 80840 before computing it, which marks it as a US health identifier.
| Digit | 8 | 0 | 8 | 4 | 0 | 1 | 6 | 6 | 9 | 1 | 5 | 8 | 8 | 7 |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Doubled? | — | ×2 | — | ×2 | — | ×2 | — | ×2 | — | ×2 | — | ×2 | — | ×2 |
| Value | 8 | 0 | 8 | 8 | 0 | 2 | 6 | 3 | 9 | 2 | 5 | 7 | 8 | 5 |
Sum = 71 · next multiple of 10 = 80 · check digit = 9 · actual last digit = 9
A valid check digit only means the number is well-formed. It does not mean the provider is licensed, active, or in good standing — those are separate questions answered by the sections above.