Individual provider Active NPI

Ashley Kim

  • Surgical Physician Assistant
  • Hollywood, FL
National Provider Identifier
1194478891
Registry record updated Feb 2, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Surgical Physician AssistantTaxonomy code 363AS0400X
Practice address
1150 N 35TH Ave
Hollywood, FL 33021-5424
Phone
(954) 265-3500
NPI assigned
Feb 2, 2022
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Feb 2, 2022

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Surgical Physician Assistant 363AS0400X Primary

Addresses

Primary practice location

1150 N 35TH Ave
Hollywood, FL 33021-5424

Mailing address

12030 NW 35TH St
Sunrise, FL 33323-1266

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in FL
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20220819000494 FL Practitioner - Physician Assistant 6204219504 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Master of Science, Physician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
South Broward Hospital District CurrentSince Mar 15, 2022 Accepting new patients
South Broward Hospital District CurrentSince Mar 15, 2022 Accepting new patients
South Broward Hospital District Past Accepting new patients

Locations

1150 N 35th Ave
Ste 520
Hollywood, FL 33021
Phone (954) 265-2423

1150 N 35th Ave
Ste 300
Hollywood, FL 33021
Phone (954) 265-1490

1865 N Corporate Lakes Blvd
Ste 1
Weston, FL 33326
Phone (954) 265-9344

Organizations & group practices 4

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": "1643760000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1643760000000",
    "number": "1194478891",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12030 NW 35TH ST",
            "city": "SUNRISE",
            "state": "FL",
            "postal_code": "333231266"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1150 N 35TH AVE",
            "city": "HOLLYWOOD",
            "state": "FL",
            "postal_code": "330215424",
            "telephone_number": "954-265-3500"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KIM",
        "first_name": "ASHLEY",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2022-02-02",
        "last_updated": "2022-02-02",
        "certification_date": "2022-02-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AS0400X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Surgical",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Hollywood, FL

Sources for this page

Verify at the official NPI Registry.