Individual provider Active NPI

Eui Kim

  • Family Nurse Practitioner
  • Emerson, NJ
National Provider Identifier
1063771202
Registry record updated Apr 5, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
26NJ00788400 Issued in NJ
Practice address
466 Old Hook Rd Ste 1
Emerson, NJ 07630-1368
Phone
(201) 967-8221
NPI assigned
May 8, 2012
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 5, 2019

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X 337269 NY
Family Nurse Practitioner 363LF0000X 26NJ00788400 NJ Primary

Addresses

Primary practice location

466 Old Hook Rd Ste 1
Emerson, NJ 07630-1368

Mailing address

466 Old Hook Rd Ste 1
Emerson, NJ 07630-1368
Phone (201) 967-8221

Other names 1

  • Eui Park Former name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NY
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20160226000304 NY Practitioner - Nurse Practitioner 5597060715 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Clvlnd Clinic Lerner College of Med of Case WSTN RSV University, 2012
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Bon Secours Charity Health System Medical Group, P.C.Group PAC ID 1658262084, 157 clinicians

Practice addresses (Care Compare)

257 Lafayette Ave
Suffern, NY 10901-4830
Phone 845353560025027

Hospital & facility affiliations

  • Good Samaritan Hospital of Suffern Hospital, Suffern, NY, CCN 330158
  • Nyack Hospital Hospital, Nyack, NY, CCN 330104

Merit-based Incentive Payment System (MIPS)

Final score
96.73 of 100Reported as apm
Quality
87.82
Promoting interoperability
92
Improvement activities
40

Merit-based Incentive Payment System (MIPS)

Final score
96.09 of 100Reported as apm
Quality
86.89
Promoting interoperability
100
Improvement activities
40

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
26NJ00788400NJMDFamily Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Bon Secours Charity Health System Medical Group, P.C. CurrentSince Nov 13, 2023 Accepting new patients

Locations

20 Grand St
Fl 3
Warwick, NY 10990
Phone (845) 987-3901

2 Crosfield Ave
Ste 318
West Nyack, NY 10994
Phone (845) 353-5600

2 Crosfield Ave
West Nyack, NY 10994
Phone (212) 725-8511

Networks

  • Healthfirst Medicare Network H9678
  • Healthfirst Medicare Network H5989
  • Healthfirst Medicare Network H1722
  • Healthfirst Medicare Network H3359

Interoperability endpoints

  • FHIR API: https://epicproxy.ardenthealth.com/fhir/PVC/api/FHIR/R4

Organizations & group practices 1

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 2

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": "1336435200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1554422400000",
    "number": "1063771202",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "466 OLD HOOK RD STE 1",
            "city": "EMERSON",
            "state": "NJ",
            "postal_code": "076301368",
            "telephone_number": "201-967-8221"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "466 OLD HOOK RD STE 1",
            "city": "EMERSON",
            "state": "NJ",
            "postal_code": "076301368",
            "telephone_number": "201-967-8221"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KIM",
        "first_name": "EUI",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2012-05-08",
        "last_updated": "2019-04-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "NY",
            "license": "337269",
            "primary": false
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "NJ",
            "license": "26NJ00788400",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "EUI",
            "last_name": "PARK",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Emerson, NJ

Sources for this page

Verify at the official NPI Registry.