Individual provider Active NPI

Jennifer J Kim, M.D.

  • Obstetrics & Gynecology Physician
  • Evanston, IL
National Provider Identifier
1083606560
Registry record updated Jan 20, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Obstetrics & Gynecology PhysicianTaxonomy code 207V00000X
License
036102320 Issued in IL
Practice address
1000 Central St Ste 717
Evanston, IL 60201-1779
Phone
(847) 864-1200
NPI assigned
Aug 19, 2005
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 20, 2020

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Obstetrics & Gynecology Physician 207V00000X 036102320 IL Primary

Addresses

Primary practice location

1000 Central St Ste 717
Evanston, IL 60201-1779

Mailing address

2801 Lakeside Dr Ste 209
Bannockburn, IL 60015-1271
Phone (847) 562-1410

Other practice location 1

601 Skokie Blvd Ste 400
Northbrook, IL 60062-2820
Phone (847) 562-1410

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IL
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
I20040316000142 IL Practitioner - Obstetrics/Gynecology 1052201076 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Obstetrics/Gynecology
Education
Loyola University of Chicago, Stritch School of Medicine, 1996
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Midwest Center for Women'S Healthcare, LTDGroup PAC ID 7012818354, 93 clinicians

Practice addresses (Care Compare)

350 S Northwest Hwy
Park Ridge, IL 60068-4262
Phone (847) 825-8108

4709 Golf Rd
Suite 320 325
Skokie, IL 60076-1231
Phone (847) 499-2648

Hospital & facility affiliations

  • Northshore University Healthsystem - Evanston Hospital Hospital, Evanston, IL, CCN 140010

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
036102320ILMDObstetrics & Gynecology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Midwest Center for Women'S Healthcare Obstetrics & Gynecology PastSince Jul 31, 2006 Accepting new patients

Interoperability endpoints

  • Direct secure messaging: jennifer.kim.1@21117.direct.athenahealth.com

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": "1124409600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1579478400000",
    "number": "1083606560",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2801 LAKESIDE DR STE 209",
            "city": "BANNOCKBURN",
            "state": "IL",
            "postal_code": "600151271",
            "telephone_number": "847-562-1410",
            "fax_number": "847-562-0830"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1000 CENTRAL ST STE 717",
            "city": "EVANSTON",
            "state": "IL",
            "postal_code": "602011779",
            "telephone_number": "847-864-1200"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "601 Skokie Blvd Ste 400",
            "address_purpose": "LOCATION",
            "city": "Northbrook",
            "state": "IL",
            "postal_code": "600622820",
            "country_code": "US",
            "telephone_number": "847-562-1410",
            "fax_number": "847-562-0830",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "KIM",
        "first_name": "JENNIFER",
        "middle_name": "J",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2005-08-19",
        "last_updated": "2020-01-20",
        "certification_date": "2020-01-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207V00000X",
            "taxonomy_group": "",
            "desc": "Obstetrics & Gynecology",
            "state": "IL",
            "license": "036102320",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Evanston, IL

Sources for this page

Verify at the official NPI Registry.