Individual provider Active NPI

Kyung Ho Kim, MD

  • Internal Medicine Physician
  • Stony Brook, NY
National Provider Identifier
1063687929
Registry record updated Nov 30, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
69785 Issued in CT
Practice address
Dept of Medicine Stony Brook University
Health Sciences Center Level 16 RM 020
Stony Brook, NY 11794-0001
Phone
(646) 522-9816
NPI assigned
Apr 23, 2008
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Nov 30, 2021

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Nephrology Physician 207RN0300X 69785 CT
Internal Medicine Physician 207R00000X 69785 CT Primary
Nephrology Physician 207RN0300X 235372 NY

Addresses

Primary practice location

Dept of Medicine Stony Brook University
Health Sciences Center Level 16 RM 020
Stony Brook, NY 11794-0001

Mailing address

2800 Main St
Bridgeport, CT 06606-4201
Phone (475) 210-5847

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CT
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
I20211206002512 CT Practitioner - Internal MedicinePractitioner - Nephrology 5698797462 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Internal MedicineAlso: Nephrology
Education
State University of New York at Stony Brook, School of Medicine, 2002
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Hartford Healthcare Medical Group Specialists PLLCGroup PAC ID 3173866241, 1,555 clinicians

Practice addresses (Care Compare)

2800 Main St
Bridgeport, CT 06606-4201
Phone (475) 210-5242

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
90.42 of 100Reported as group
Quality
83.36
Promoting interoperability
100
Improvement activities
40
Cost
75.9

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
69785CTMDInternal Medicine Physician
235372NYMDNephrology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Hartford Healthcare Medical Group Specialists, PLLC CurrentSince Jan 1, 2022 Accepting new patients
Hartford Healthcare Medical Group Specialists LLC CurrentSince Jan 1, 2022 Accepting new patients

Locations

2800 Main St
Bridgeport, CT 06606
Phone (203) 386-0366

1244 Storrs Rd
Storrs Mansfield, CT 06268
Phone (860) 724-2579

1290 Silas Deane Hwy
Wethersfield, CT 06109
Phone (860) 972-6977

Interoperability endpoints

  • Direct secure messaging: kyung.kim@xdr.hhchealthdirect.org

Organizations & group practices 2

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": "1208908800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1638230400000",
    "number": "1063687929",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2800 MAIN ST",
            "city": "BRIDGEPORT",
            "state": "CT",
            "postal_code": "066064201",
            "telephone_number": "475-210-5847",
            "fax_number": "860-972-7040"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "DEPT OF MEDICINE STONY BROOK UNIVERSITY",
            "address_2": "HEALTH SCIENCES CENTER LEVEL 16 RM 020",
            "city": "STONY BROOK",
            "state": "NY",
            "postal_code": "117940001",
            "telephone_number": "646-522-9816"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KIM",
        "first_name": "KYUNG HO",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2008-04-23",
        "last_updated": "2021-11-30",
        "certification_date": "2021-11-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207RN0300X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Nephrology",
            "state": "CT",
            "license": "69785",
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "CT",
            "license": "69785",
            "primary": true
        },
        {
            "code": "207RN0300X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Nephrology",
            "state": "NY",
            "license": "235372",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Stony Brook, NY

Sources for this page

Verify at the official NPI Registry.