NPIMap

Individual provider Active NPI

Daniel Lee Kim, MD

  • Urogynecology and Reconstructive Pelvic Surgery (Obstetrics & Gynecology) Physician
  • Port Matilda, PA
National Provider Identifier
1114986817
Registry record updated Jul 8, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Urogynecology and Reconstructive Pelvic Surgery (Obstetrics & Gynecology) PhysicianTaxonomy code 207VF0040X
License
MD065991L Issued in PA
Practice address
132 Abigail LN
Port Matilda, PA 16870-7153
Phone
(814) 272-5011
Fax
(814) 272-6531
NPI assigned
Mar 21, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 8, 2022

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Urogynecology and Reconstructive Pelvic Surgery (Obstetrics & Gynecology) Physician 207VF0040X D00065837 MD
Gynecology Physician 207VG0400X 223931 NY
Urogynecology and Reconstructive Pelvic Surgery (Obstetrics & Gynecology) Physician 207VF0040X MD065991L PA Primary

Addresses

Primary practice location

132 Abigail LN
Port Matilda, PA 16870-7153

Mailing address

100 N Academy Ave
Danville, PA 17822-4903
Phone (570) 271-6144

Other identifiers 1

IdentifierTypeStateIssuer
02248355MedicaidNY

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
I20220628000491 PA Practitioner - Obstetrics/Gynecology 2860413408 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Obstetrics/Gynecology
Education
Other, 1995
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Geisinger ClinicGroup PAC ID 5395657001, 3,432 clinicians
Keystone Rehabilitation Systems IncGroup PAC ID 7012826753, shared by 15 NPIs, 750 clinicians

Practice addresses (Care Compare)

132 Abigail LN
Port Matilda, PA 16870-7153
Phone (814) 272-7100

526 Westerly Pkwy
State College, PA 16801-5905
Phone (814) 996-1150

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Removal of the uterus1-10

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
D00065837MDMDFemale Pelvic Medicine and Reconstructive Surgery (Obstetrics & Gynecology) Physician
MD065991LPAMDFemale Pelvic Medicine and Reconstructive Surgery (Obstetrics & Gynecology) Physician
223931NYMDGynecology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Geisinger Clinic CurrentSince Jul 1, 2022 Accepting new patients
Geisinger Clinic Current Accepting new patients
Geisinger Clinic CurrentSince Jul 1, 2022 Accepting new patients
Geisinger Clinic Past Accepting new patients
Sandra J. Greco, MD, Facog, PA Gynecology Past Accepting new patients
Barnabas Health Medical Group, PC PastSince Apr 19, 2004 Accepting new patients
Frederick Health Hospital Inc Past Accepting new patients
OB GYN Associates at Long Island College Hospital Gynecology Past Accepting new patients

Locations

100 N Academy Ave
Danville, PA 17822

132 Abigail Ln
Port Matilda, PA 16870
Phone (814) 272-5011

Interoperability endpoints

  • FHIR API: https://api.platform.athenahealth.com/8414/brand/1/csg/1/fhir/r4
  • Direct secure messaging: dkim499837@direct.geisinger.edu

Organizations & group practices 8

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 68

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

View all 68

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1142899200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1657238400000",
    "number": "1114986817",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "100 N ACADEMY AVE",
            "city": "DANVILLE",
            "state": "PA",
            "postal_code": "178224903",
            "telephone_number": "570-271-6144",
            "fax_number": "570-271-6578"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "132 ABIGAIL LN",
            "city": "PORT MATILDA",
            "state": "PA",
            "postal_code": "168707153",
            "telephone_number": "814-272-5011",
            "fax_number": "814-272-6531"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KIM",
        "first_name": "DANIEL",
        "middle_name": "LEE",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-03-21",
        "last_updated": "2022-07-08",
        "certification_date": "2022-02-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207VF0040X",
            "taxonomy_group": "",
            "desc": "Obstetrics & Gynecology, Urogynecology and Reconstructive Pelvic Surgery",
            "state": "MD",
            "license": "D00065837",
            "primary": false
        },
        {
            "code": "207VG0400X",
            "taxonomy_group": "",
            "desc": "Obstetrics & Gynecology, Gynecology",
            "state": "NY",
            "license": "223931",
            "primary": false
        },
        {
            "code": "207VF0040X",
            "taxonomy_group": "",
            "desc": "Obstetrics & Gynecology, Urogynecology and Reconstructive Pelvic Surgery",
            "state": "PA",
            "license": "MD065991L",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "02248355",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Port Matilda, PA

Sources for this page

Verify at the official NPI Registry.