Individual provider Active NPI

Soyoun Im, M.D.

  • Internal Medicine Physician
  • New York, NY
National Provider Identifier
1073753679
Registry record updated Sep 5, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
262556 Issued in NY
Practice address
130 E 77TH St
Lenox Hill Hospital- 6 Black Hall
New York, NY 10075-1851
Phone
(917) 569-5906
NPI assigned
Feb 23, 2009
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 5, 2012

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X 262556 NY Primary

Addresses

Primary practice location

130 E 77TH St
Lenox Hill Hospital- 6 Black Hall
New York, NY 10075-1851

Mailing address

130 E 77TH St
Lenox Hill Hospital- 6 Black Hall
New York, NY 10075-1851
Phone (917) 569-5906

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: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20130118000045 NY Practitioner - Internal Medicine 3779736079 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Internal Medicine
Education
Albert Einstein College of Medicine of Yeshiva University, 2008
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
North Shore-Lij Medical PCGroup PAC ID 3375701568, 6,374 clinicians

Practice addresses (Care Compare)

178 E 85TH St
New York, NY 10028-2119

300 Community Dr
Manhasset, NY 11030-3816

300 Community Dr LL
Manhasset, NY 11030-3816
Phone (516) 562-2229

330 Community Dr
Manhasset, NY 11030-3816
Phone (516) 708-2550

350 Community Dr
Manhasset, NY 11030-3816
Phone (516) 562-3845

Hospital & facility affiliations

  • Lenox Hill Hospital Hospital, New York, NY, CCN 330119

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
262556NYMDInternal Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
North Shore - Lij Medical PC Internal Medicine CurrentSince Aug 13, 2012 Accepting new patients
Advantagecare Physicians PC CurrentSince Feb 25, 2017 Accepting new patients
Advantagecare Physicians PC Internal Medicine CurrentSince Feb 25, 2017 Accepting new patients
North Shore-Lij Medical PC Internal Medicine CurrentSince Aug 13, 2012 Accepting new patients

Locations

233 Nostrand Ave
Brooklyn, NY 11205
Phone (646) 680-1595

3175 23rd St
Long Island City, NY 11106
Phone (718) 956-2200

130 E 77th St
#6
New York, NY 10075
Phone (917) 569-5906

233 Broadway
Rm 2750
New York, NY 10279
Phone (212) 889-5544

300 Community Dr
Plandome, NY 11030

972 Brush Hollow Rd
Westbury, NY 11590

Networks

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

Interoperability endpoints

  • Direct secure messaging: sim28294@northwell.direct-ci.com
  • FHIR API: https://epwebapps.acpny.com/FHIRproxy/ACPNY/api/FHIR/R4

Organizations & group practices 4

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": "1235347200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1346803200000",
    "number": "1073753679",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "130 E 77TH ST",
            "address_2": "LENOX HILL HOSPITAL- 6 BLACK HALL",
            "city": "NEW YORK",
            "state": "NY",
            "postal_code": "100751851",
            "telephone_number": "917-569-5906"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "130 E 77TH ST",
            "address_2": "LENOX HILL HOSPITAL- 6 BLACK HALL",
            "city": "NEW YORK",
            "state": "NY",
            "postal_code": "100751851",
            "telephone_number": "917-569-5906"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "IM",
        "first_name": "SOYOUN",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2009-02-23",
        "last_updated": "2012-09-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "NY",
            "license": "262556",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in New York, NY

Sources for this page

Verify at the official NPI Registry.