NPIMap

Individual provider Active NPI

Sam Eun Kim, M.D.

  • Internal Medicine Physician
  • Odessa, TX
National Provider Identifier
1093987885
Registry record updated Jul 12, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
N0891 Issued in TX
Practice address
8050 E Highway 191
Ste 200
Odessa, TX 79765-8613
Phone
(432) 337-5411
Fax
(432) 561-5014
NPI assigned
Apr 1, 2008
Last updated
Jul 12, 2019By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 12, 2019

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 N0891 TX Primary

Addresses

Primary practice location

8050 E Highway 191
Ste 200
Odessa, TX 79765-8613

Mailing address

PO Box 2129
Odessa, TX 79760-2129
Phone (432) 337-5411

Other identifiers 1

IdentifierTypeStateIssuer
199366903MedicaidTX

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TX
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20081121000505 TX Practitioner - Internal Medicine 8820158702 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Internal Medicine
Education
Other, 2000
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
MCH Professional CareGroup PAC ID 1658358635, 51 clinicians

Practice addresses (Care Compare)

8050 E Hwy 191
Suite 200
Odessa, TX 79765-8615
Phone (432) 337-5411

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
N0891TXMDInternal Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
MCH Professional Care Internal Medicine CurrentSince Mar 1, 2017 Accepting new patients

Locations

315 Golder Ave
Ste B
Odessa, TX 79761
Phone (432) 332-2695

8050 E Highway 191
Ste 200
Odessa, TX 79765
Phone (432) 337-5411

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 8

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": "1207008000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1562889600000",
    "number": "1093987885",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 2129",
            "city": "ODESSA",
            "state": "TX",
            "postal_code": "797602129",
            "telephone_number": "432-337-5411",
            "fax_number": "432-561-5014"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8050 E HIGHWAY 191",
            "address_2": "STE 200",
            "city": "ODESSA",
            "state": "TX",
            "postal_code": "797658613",
            "telephone_number": "432-337-5411",
            "fax_number": "432-561-5014"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KIM",
        "first_name": "SAM EUN",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2008-04-01",
        "last_updated": "2019-07-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "TX",
            "license": "N0891",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "199366903",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Odessa, TX

Sources for this page

Verify at the official NPI Registry.