Individual provider Active NPI

Charles C. Kim, M.D.

  • Anesthesiology Physician
  • Naperville, IL
National Provider Identifier
1184672016
Registry record updated May 9, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Anesthesiology PhysicianTaxonomy code 207L00000X
License
036088002 Issued in IL
Practice address
801 S Washington St
Naperville, IL 60540-7430
Phone
(630) 355-0450
NPI assigned
May 4, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 9, 2017

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Anesthesiology Physician 207L00000X 036088002 IL Primary
Interventional Pain Medicine Physician 208VP0014X 036088002 IL

Addresses

Primary practice location

801 S Washington St
Naperville, IL 60540-7430

Mailing address

387 Shuman Blvd
Suite 240W
Naperville, IL 60563-8450
Phone (630) 355-0450

Other identifiers 1

IdentifierTypeStateIssuer
036088002MedicaidIL

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
I20040621001256 IL Practitioner - AnesthesiologyPractitioner - Interventional Pain Management 5193708014 Reassigns benefits to 3 organizations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
036088002ILMDInterventional Pain Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Adventist Health Partners,Inc CurrentSince Nov 18, 2024 Accepting new patients
Dupage Valley Anesthesiologists, LTD. Anesthesiology CurrentSince Jul 1, 1998 Accepting new patients
Adventist Health Partners, Inc. CurrentSince Nov 18, 2024 Accepting new patients
Northstar Anesthesia of Illinois, LLC Anesthesiology CurrentSince Jan 19, 2025 Accepting new patients
Chicago Area Partners in Anesthesia LLC Anesthesiology Past Accepting new patients

Locations

396 Remington Blvd
Ste 231
Bolingbrook, IL 60440
Phone (630) 312-4301

801 S Washington St
Naperville, IL 60540
Phone (312) 355-0450

387 Shuman Blvd
Ste 240W
Naperville, IL 60563

1423 Chicago Rd
Sauk Village, IL 60411
Phone (708) 679-2160

Organizations & group practices 5

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.

NPI Registry JSON

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

{
    "created_epoch": "1146700800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1494288000000",
    "number": "1184672016",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "387 SHUMAN BLVD",
            "address_2": "SUITE 240W",
            "city": "NAPERVILLE",
            "state": "IL",
            "postal_code": "605638450",
            "telephone_number": "630-355-0450"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "801 S WASHINGTON ST",
            "city": "NAPERVILLE",
            "state": "IL",
            "postal_code": "605407430",
            "telephone_number": "630-355-0450"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KIM",
        "first_name": "CHARLES",
        "middle_name": "C.",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-05-04",
        "last_updated": "2017-05-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207L00000X",
            "taxonomy_group": "",
            "desc": "Anesthesiology",
            "state": "IL",
            "license": "036088002",
            "primary": true
        },
        {
            "code": "208VP0014X",
            "taxonomy_group": "",
            "desc": "Pain Medicine, Interventional Pain Medicine",
            "state": "IL",
            "license": "036088002",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "036088002",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Naperville, IL

Sources for this page

Verify at the official NPI Registry.