Individual provider Active NPI

Caroline Shim, MD

  • Pediatrics Physician
  • Pacific Palisades, CA
National Provider Identifier
1043359284
Registry record updated Jan 25, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatrics PhysicianTaxonomy code 208000000X
License
A76783 Issued in CA
Practice address
881 Alma Real Dr Ste 316
Pacific Palisades, CA 90272-5061
Phone
(310) 454-2296
Fax
(310) 454-2295
NPI assigned
Feb 5, 2007
Last updated
Jan 25, 2024By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 25, 2024

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Specialist 174400000X A76783 CA
Pediatrics Physician 208000000X A76783 CA Primary

Addresses

Primary practice location

881 Alma Real Dr Ste 316
Pacific Palisades, CA 90272-5061

Mailing address

910 Via de la Paz
Suite 207
Pacific Palisades, CA 90272-3515
Phone (310) 454-4466

Other practice location 1

970 Monument St Ste 220
Pacific Palisades, CA 90272-3898
Phone (310) 454-2296

Electronic endpoints 2

TypeEndpointUseAffiliation
Direct Messaging Address cshim473199@oc.providencedirect.org
Direct Messaging Address cshim473199@oc.providencedirect.org

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20161117002675 CA Practitioner - Pediatric Medicine 2365721123 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
A76783CAMDPediatrics Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Providence Saint Johns Medical Foundation Specialist CurrentSince Jul 1, 2018 Accepting new patients
Providence Saint John's Health Center Past Accepting new patients
Palisades Pediatrics Specialist Past Accepting new patients

Locations

12414 Exposition Blvd
Los Angeles, CA 90064
Phone (310) 272-7640

881 Alma Real Dr
Ste 101
Pacific Palisades, CA 90272
Phone (310) 454-2296

970 Monument St
Ste 220
Pacific Palisades, CA 90272
Phone (310) 454-2296

881 Alma Real Dr
Ste 316
Pacific Plsds, CA 90272
Phone (310) 454-1317

2021 Santa Monica Blvd
Ste 245E
Santa Monica, CA 90404
Phone (310) 829-4403

2121 Santa Monica Blvd
Santa Monica, CA 90404
Phone (310) 281-2024

2020 Santa Monica Blvd
Ste 300
Santa Monica, CA 90404
Phone (310) 582-7312

901 Wilshire Blvd
Fl 2
Santa Monica, CA 90401
Phone (310) 829-8908

2336 Santa Monica Blvd
Ste 204
Santa Monica, CA 90404
Phone (310) 453-4477

Networks

  • BSC 65 PLUS INDIVIDUAL MAPD

Organizations & group practices 3

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1170633600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1706140800000",
    "number": "1043359284",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "910 VIA DE LA PAZ",
            "address_2": "SUITE 207",
            "city": "PACIFIC PALISADES",
            "state": "CA",
            "postal_code": "902723515",
            "telephone_number": "310-454-4466",
            "fax_number": "310-454-0916"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "881 ALMA REAL DR STE 316",
            "city": "PACIFIC PALISADES",
            "state": "CA",
            "postal_code": "902725061",
            "telephone_number": "310-454-2296",
            "fax_number": "310-454-2295"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "970 Monument St Ste 220",
            "address_purpose": "LOCATION",
            "city": "Pacific Palisades",
            "state": "CA",
            "postal_code": "902723898",
            "country_code": "US",
            "telephone_number": "310-454-2296",
            "fax_number": "310-454-2295",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "SHIM",
        "first_name": "CAROLINE",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-02-05",
        "last_updated": "2024-01-25",
        "certification_date": "2024-01-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "",
            "desc": "Specialist",
            "state": "CA",
            "license": "A76783",
            "primary": false
        },
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "CA",
            "license": "A76783",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "cshim473199@oc.providencedirect.org",
            "affiliation": "N",
            "address_1": "881 Alma Real Dr Ste 101",
            "city": "Pacific Palisades",
            "state": "CA",
            "country_code": "US",
            "postal_code": "902723792",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "cshim473199@oc.providencedirect.org",
            "affiliation": "N",
            "address_1": "881 Alma Real Dr Ste 316",
            "city": "Pacific Palisades",
            "state": "CA",
            "country_code": "US",
            "postal_code": "902725061",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Pacific Palisades, CA

Sources for this page

Verify at the official NPI Registry.