Active NPI
Sharon Kim, PH.D.
- Psychologist
- Baltimore, MD
National Provider Identifier
1184960841
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Psychologist
- License
- 06395
- Practice address
- 1111 N Charles St
Baltimore, MD 21201-5505 - Phone
- (410) 837-2050
- Fax
- (866) 629-0091
- NPI assigned
- Dec 27, 2012
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 3
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Psychologist | 103T00000X | PS017668 | PA | |
| Mental Health Counselor | 101YM0800X | |||
| Psychologist | 103T00000X | 06395 | MD | Primary |
Addresses
Primary practice location
1111 N Charles St
Baltimore, MD 21201-5505
Mailing address
1111 N Charles St
Baltimore, MD 21201-5505
Phone (410) 837-2050
Other practice location 1
15 Wyntre Brooke Dr
York, PA 17403-4509
Phone (717) 739-6576
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 102974417 | Medicaid | PA |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in PA, MD
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: No
- Power mobility devices: No
- Hospice: No
Enrollment records 2
Care Compare profile
Medicare Care Compare- Specialty
- Clinical Psychologist
- Education
- Other, 2013
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
Practice addresses (Care Compare)
1111 N Charles St
Baltimore, MD 21201-5505
Phone (410) 837-2050
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Philosophy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PS017668 | PA | MD | Psychologist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Chase Brexton Health Services, Inc. | Current | Accepting new patients | |
| Chase Brexton Health Services, Inc. | Mental Health | Current | Accepting new patients |
Locations
1111 N Charles St
Baltimore, MD 21201
Phone (410) 486-5991
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.
-
- Federally Qualified Health Center (FQHC)
- Baltimore, MD
- NPI 1588606305
-
- Federally Qualified Health Center (FQHC)
- Columbia, MD
- NPI 1376589309
Mental Health
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1356566400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1613520000000",
"number": "1184960841",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1111 N CHARLES ST",
"city": "BALTIMORE",
"state": "MD",
"postal_code": "212015505",
"telephone_number": "410-837-2050"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1111 N CHARLES ST",
"city": "BALTIMORE",
"state": "MD",
"postal_code": "212015505",
"telephone_number": "410-837-2050",
"fax_number": "866-629-0091"
}
],
"practiceLocations": [
{
"address_1": "15 Wyntre Brooke Dr",
"address_purpose": "LOCATION",
"city": "York",
"state": "PA",
"postal_code": "174034509",
"country_code": "US",
"telephone_number": "717-739-6576",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "KIM",
"first_name": "SHARON",
"name_prefix": "Dr.",
"credential": "PH.D.",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2012-12-27",
"last_updated": "2021-02-17",
"certification_date": "2021-02-17",
"status": "A"
},
"taxonomies": [
{
"code": "103T00000X",
"taxonomy_group": "",
"desc": "Psychologist",
"state": "PA",
"license": "PS017668",
"primary": false
},
{
"code": "101YM0800X",
"taxonomy_group": "",
"desc": "Counselor, Mental Health",
"state": null,
"license": null,
"primary": false
},
{
"code": "103T00000X",
"taxonomy_group": "",
"desc": "Psychologist",
"state": "MD",
"license": "06395",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "102974417",
"state": "PA"
}
],
"endpoints": [],
"other_names": []
}
Other providers in Baltimore, MD
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 17, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.