Active NPI
Jae Gyeom Kim, AA-S
- Anesthesiologist Assistant
- Saint Louis, MO
National Provider Identifier
1194257287
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Anesthesiologist Assistant
- License
- 2017016393
- Practice address
- 615 S New Ballas Rd
Saint Louis, MO 63141-8221 - Phone
- (636) 386-9224
- Fax
- (636) 386-7679
- NPI assigned
- Mar 29, 2017
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Anesthesiologist Assistant | 367H00000X | 2017016393 | MO | Primary |
Addresses
Primary practice location
615 S New Ballas Rd
Saint Louis, MO 63141-8221
Mailing address
339 Consort Dr
Ballwin, MO 63011-4439
Phone (636) 386-9224
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in MO
Enrollment records 1
Care Compare profile
Medicare Care Compare- Specialty
- Anesthesiology Assistant
- Education
- Clvlnd Clinic Lerner College of Med of Case WSTN RSV University, 2017
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
Practice addresses (Care Compare)
615 S New Ballas Rd
Saint Louis, MO 63141-8221
Phone (314) 251-4687
Hospital & facility affiliations
- Mercy Hospital St Louis
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Associate of Arts, Associate of Applied Science
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 2017016393 | MO | MD | Anesthesiologist Assistant |
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 and National Provider Directory roles.
-
- Anesthesiology Physician
- Saint Louis, MO
- NPI 1275646754
Hospital & facility affiliations 2
Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.
-
- General Acute Care Hospital
- Saint Louis, MO
- NPI 1427098169
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1490745600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1743724800000",
"number": "1194257287",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "339 CONSORT DR",
"city": "BALLWIN",
"state": "MO",
"postal_code": "630114439",
"telephone_number": "636-386-9224",
"fax_number": "636-200-4243"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "615 S NEW BALLAS RD",
"city": "SAINT LOUIS",
"state": "MO",
"postal_code": "631418221",
"telephone_number": "636-386-9224",
"fax_number": "636-386-7679"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KIM",
"first_name": "JAE GYEOM",
"name_prefix": "Mr.",
"credential": "AA-S",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2017-03-29",
"last_updated": "2025-04-04",
"certification_date": "2025-04-04",
"status": "A"
},
"taxonomies": [
{
"code": "367H00000X",
"taxonomy_group": "",
"desc": "Anesthesiologist Assistant",
"state": "MO",
"license": "2017016393",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Saint Louis, MO
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 4, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
- 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.