NPIMap

Individual provider Active NPI

Chong Hwan Kim, MD

  • Psychiatry Physician
  • Philadelphia, PA
National Provider Identifier
1114972825
Registry record updated Oct 2, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatry PhysicianTaxonomy code 2084P0800X
License
MD425893 Issued in PA
Practice address
101 E Olney Ave
Suite 400
Philadelphia, PA 19120-2421
Phone
(215) 456-7000
Fax
(215) 254-2599
NPI assigned
May 23, 2006
Last updated
Oct 2, 2019By the provider in NPPES
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Oct 2, 2019

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Neurology Physician 2084N0400X MD425893 PA
Psychiatry Physician 2084P0800X MD425893 PA Primary

Addresses

Primary practice location

101 E Olney Ave
Suite 400
Philadelphia, PA 19120-2421

Mailing address

5501 Old York Rd
Philadelphia, PA 19141-3018
Phone (215) 456-8103

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in PA
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
I20060824000305 PA Practitioner - Psychiatry 1759384191 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Psychiatry
Education
Other, 1995
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
St Lukes Physician Group IncGroup PAC ID 6709798333, 2,161 clinicians

Practice addresses (Care Compare)

1107 Eaton Ave
St Lukes Psych Assoc
Bethlehem, PA 18018-1862
Phone (610) 954-3012

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
97.13 of 100Reported as apm
Quality
82.27
Promoting interoperability
100
Improvement activities
40

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
MD425893PAMDNeurology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Penn Foundation Inc CurrentSince Jan 9, 2025 Accepting new patients
St. Luke's Physician Group, Inc. Psychiatry CurrentSince Oct 1, 2019 Accepting new patients
Belmont Behavioral Hospital, LLC CurrentSince Jul 1, 2015 Accepting new patients
Belmont Behavioral Hospital, LLC Current Accepting new patients
St. Luke's Physician Group, Inc. Current Accepting new patients
St Luke's Physician Group Inc CurrentSince Oct 1, 2019 Accepting new patients
St. Luke's Hospital Past Accepting new patients

Locations

1107 Eaton Ave
Bethlehem, PA 18018
Phone (610) 954-3012

801 Ostrum St
Fountain Hill, PA 18015
Phone (610) 954-2200

4200 Monument Rd
Philadelphia, PA 19131
Phone (215) 456-6611

807 Lawn Ave
Sellersville, PA 18960

Interoperability endpoints

  • Direct secure messaging: chong.kim@slpg.direct-sluhn.org

Organizations & group practices 7

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 9

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": "1148342400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1569974400000",
    "number": "1114972825",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5501 OLD YORK RD",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "191413018",
            "telephone_number": "215-456-8103",
            "fax_number": "215-254-2599"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "101 E OLNEY AVE",
            "address_2": "SUITE 400",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "191202421",
            "telephone_number": "215-456-7000",
            "fax_number": "215-254-2599"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KIM",
        "first_name": "CHONG",
        "middle_name": "HWAN",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-05-23",
        "last_updated": "2019-10-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2084N0400X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Neurology",
            "state": "PA",
            "license": "MD425893",
            "primary": false
        },
        {
            "code": "2084P0800X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "PA",
            "license": "MD425893",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Philadelphia, PA

Sources for this page

Verify at the official NPI Registry.