NPIMap

Individual provider Active NPI

Bong-Soo Kim, M.D.

  • Neurological Surgery Physician
  • Philadelphia, PA
National Provider Identifier
1053553487
Registry record updated May 1, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Neurological Surgery PhysicianTaxonomy code 207T00000X
License
MD 434999 Issued in PA
Practice address
3509 N Broad St
Philadelphia, PA 19140-4105
Phone
(215) 707-7200
Fax
(215) 707-3831
NPI assigned
Mar 31, 2009
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 1, 2018

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Neurological Surgery Physician 207T00000X MD 434999 PA Primary

Addresses

Primary practice location

3509 N Broad St
Philadelphia, PA 19140-4105

Mailing address

2450 W Hunting Park Ave
Philadelphia, PA 19129-1302
Phone (215) 707-7200

Other practice location 1

3401 N Broad St
Neurosurgery
Philadelphia, PA 19140-5103
Phone (215) 707-7200

Other identifiers 1

IdentifierTypeStateIssuer
1063553498OtherPA1063553498

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20090922000149 PA Practitioner - Neurosurgery 2567518228 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Neurosurgery
Education
Other, 1991
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Temple Faculty Practice Plan IncGroup PAC ID 0345588711, 1,325 clinicians

Practice addresses (Care Compare)

3509 N Broad St
Philadelphia, PA 19140-4105
Phone (215) 707-2111

Hospital & facility affiliations

  • Temple University Hospital Hospital, Philadelphia, PA, CCN 390027

Merit-based Incentive Payment System (MIPS)

Final score
81.21 of 100Reported as group
Quality
49.71
Promoting interoperability
100
Improvement activities
40
Cost
74.23

Procedures performed for Medicare patients

ProcedureNumber of procedures
Spinal fusion60
Laminectomy or laminotomy (partial removal of spine bones)21

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
MD 434999PAMDNeurological Surgery Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Temple Faculty Practice Plan Inc CurrentSince Mar 10, 2019 Accepting new patients
Temple Faculty Practice Plan Inc Current Accepting new patients
Temple Faculty Practice Plan Inc CurrentSince Mar 10, 2019 Accepting new patients
Temple Faculty Practice Plan Inc Past Accepting new patients
Temple University Hospital, Inc Past Accepting new patients

Locations

1648 Huntingdon Pike
Meadowbrook, PA 19046
Phone (215) 938-3413

1650 Huntingdon Pike
Ste 154
Meadowbrook, PA 19046
Phone (215) 938-1661

2450 W Hunting Park Ave
Philadelphia, PA 19129
Phone (215) 707-2433

3401 N Broad St
Philadelphia, PA 19140
Phone (215) 707-3807

7500 Central Ave
Philadelphia, PA 19111
Phone (215) 214-4100

1331 E Wyoming Ave
Philadelphia, PA 19124
Phone (215) 537-7400

3509 N Broad St
Philadelphia, PA 19140
Phone (215) 707-2433

Organizations & group practices 5

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

Hospital & facility affiliations 8

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1238457600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1525132800000",
    "number": "1053553487",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2450 W HUNTING PARK AVE",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "191291302",
            "telephone_number": "215-707-7200",
            "fax_number": "215-707-3831"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3509 N BROAD ST",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "191404105",
            "telephone_number": "215-707-7200",
            "fax_number": "215-707-3831"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "3401 N Broad St",
            "address_2": "Neurosurgery",
            "address_purpose": "LOCATION",
            "city": "Philadelphia",
            "state": "PA",
            "postal_code": "191405103",
            "country_code": "US",
            "telephone_number": "215-707-7200",
            "fax_number": "215-707-3831",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "KIM",
        "first_name": "BONG-SOO",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2009-03-31",
        "last_updated": "2018-05-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207T00000X",
            "taxonomy_group": "",
            "desc": "Neurological Surgery",
            "state": "PA",
            "license": "MD 434999",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "1063553498",
            "identifier": "1063553498",
            "state": "PA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Philadelphia, PA

Sources for this page

Verify at the official NPI Registry.