Individual provider Active NPI

Doris Kim, MD

  • Surgery Physician
  • Madison, WI
National Provider Identifier
1053793141
Registry record updated May 8, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Surgery PhysicianTaxonomy code 208600000X
License
82001-20 Issued in WI
Practice address
700 S Park St Ste a
Madison, WI 53715-1830
Phone
(608) 260-2900
Fax
(608) 260-2976
NPI assigned
Jun 24, 2015
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 8, 2023

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Surgery Physician 208600000X 82001-20 WI Primary
Surgery Physician 208600000X MMD.38497 LL SC

Addresses

Primary practice location

700 S Park St Ste a
Madison, WI 53715-1830

Mailing address

700 S Park St Ste a
Madison, WI 53715-1830
Phone (608) 260-2900

Other practice location 1

2335 Stockton Blvd
NAOB 5th floor
Sacramento, CA 95811
Phone (916) 734-2680

Other identifiers 1

IdentifierTypeStateIssuer
1053793141MedicaidWI

Electronic endpoints 3

TypeEndpointUseAffiliation
Direct Messaging Address dkim443683@direct-ehr-ssmhc.com Direct
Direct Messaging Address kimdor@ucdavis.edu
FHIR URL https://fhir.ssmhc.com/fhir/api/FHIR/DSTU2/ Other

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA, WI2 enrollments
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 2

Enrollment IDStateProvider typePAC IDDetails
I20200826001958 CA Practitioner - General Surgery 3779883012 Reassigns benefits to 1 organization
I20230308000537 WI Practitioner - General Surgery 3779883012 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
General Surgery
Education
Other, 2015
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Dean Health Systems IncGroup PAC ID 7012827983, 1,174 clinicians

Practice addresses (Care Compare)

10 Tower Dr
Sun Prairie, WI 53590-1239
Phone (608) 825-3500

1211 Fish Hatchery Rd
Madison, WI 53715-1909
Phone (608) 252-8000

1821 S Stoughton Rd
Madison, WI 53716-2257
Phone (608) 260-6000

3400 E Racine St
Janesville, WI 53546-2344
Phone (608) 373-8000

515 22ND Ave
Monroe, WI 53566-1569
Phone (608) 324-2000

700 S Park St
Madison, WI 53715-1830
Phone (608) 251-6100

752 N High Point Rd
Madison, WI 53717-2236
Phone (608) 824-4000

753 N Main St
Oregon, WI 53575-1003
Phone (608) 835-2222

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Hernia repair - groin (open)1-10
Hernia repair (minimally invasive)25
Upper gastrointestinal (GI) endoscopy for acid reflux21
Melanoma (skin cancer) excision1-10

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
MMD.38497 LLSCMDSurgery Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Regents of the Univ of Ca CurrentSince Aug 6, 2020 Accepting new patients
Dean Health Systems, Inc. CurrentSince Feb 23, 2023 Accepting new patients
Dean Health Systems, Inc CurrentSince Feb 23, 2023 Accepting new patients
Regents of the Univ of Ca Current Accepting new patients
Regents of the Univ of Ca Surgery CurrentSince Aug 6, 2020 Accepting new patients

Locations

2221 Stockton Blvd
Sacramento, CA 95817
Phone (916) 734-2680

4900 Broadway
Ste 2800
Sacramento, CA 95820
Phone (916) 734-9313

1808 W Beltline Hwy
Madison, WI 53713
Phone (608) 250-1497

700 S Park St
Ste A
Madison, WI 53715
Phone (608) 260-2900

515 22nd Ave
Monroe, WI 53566
Phone (608) 324-1000

Interoperability endpoints

  • Direct secure messaging: dkim443683@direct-ehr-ssmhc.com

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 1

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": "1435104000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1683504000000",
    "number": "1053793141",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "700 S PARK ST STE A",
            "city": "MADISON",
            "state": "WI",
            "postal_code": "537151830",
            "telephone_number": "608-260-2900",
            "fax_number": "608-260-2976"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "700 S PARK ST STE A",
            "city": "MADISON",
            "state": "WI",
            "postal_code": "537151830",
            "telephone_number": "608-260-2900",
            "fax_number": "608-260-2976"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2335 Stockton Blvd",
            "address_2": "NAOB 5th floor",
            "address_purpose": "LOCATION",
            "city": "Sacramento",
            "state": "CA",
            "postal_code": "95811",
            "country_code": "US",
            "telephone_number": "916-734-2680",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "KIM",
        "first_name": "DORIS",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2015-06-24",
        "last_updated": "2023-05-08",
        "certification_date": "2023-05-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208600000X",
            "taxonomy_group": "",
            "desc": "Surgery",
            "state": "WI",
            "license": "82001-20",
            "primary": true
        },
        {
            "code": "208600000X",
            "taxonomy_group": "",
            "desc": "Surgery",
            "state": "SC",
            "license": "MMD.38497 LL",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1053793141",
            "state": "WI"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "dkim443683@direct-ehr-ssmhc.com",
            "affiliation": "N",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "dkim443683@direct-ehr-ssmhc.com",
            "address_1": "700 S Park St Ste A",
            "city": "Madison",
            "state": "WI",
            "country_code": "US",
            "postal_code": "537151830",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "kimdor@ucdavis.edu",
            "affiliation": "N",
            "address_1": "2335 Stockton Blvd",
            "address_2": "NAOB- 5th floor",
            "city": "Sacramento",
            "state": "CA",
            "country_code": "US",
            "postal_code": "95817",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "FHIR",
            "endpointTypeDescription": "FHIR URL",
            "endpoint": "https://fhir.ssmhc.com/fhir/api/FHIR/DSTU2/",
            "affiliation": "N",
            "use": "OTHER",
            "useDescription": "Other",
            "useOtherDescription": "FHIR API",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "CCD",
            "address_1": "700 S Park St Ste A",
            "city": "Madison",
            "state": "WI",
            "country_code": "US",
            "postal_code": "537151830",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Madison, WI

Sources for this page

Verify at the official NPI Registry.