Individual provider Active NPI

Suzy L. Kim, M.D.

  • Gastroenterology Physician
  • Greenville, SC
National Provider Identifier
1205929965
Registry record updated May 24, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Gastroenterology PhysicianTaxonomy code 207RG0100X
License
20123 Issued in SC
Practice address
200 Patewood Dr
Suite B200
Greenville, SC 29615-3593
Phone
(864) 232-7338
Fax
(864) 239-6645
NPI assigned
Oct 2, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 24, 2011

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Gastroenterology Physician 207RG0100X 20123 SC Primary

Addresses

Primary practice location

200 Patewood Dr
Suite B200
Greenville, SC 29615-3593

Mailing address

P. O. Box 8676
Greenville, SC 29604-8676
Phone (864) 232-7338

Other identifiers 1

IdentifierTypeStateIssuer
201230MedicaidSC

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in SC
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
I20031215000133 SC Practitioner - Gastroenterology 1052218575 Reassigns benefits to 2 organizations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
20123SCMDGastroenterology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Gastroenterology Associates, PA Gastroenterology CurrentSince Nov 1, 2002 Accepting new patients
Gastroenterology Associates, PA Gastroenterology CurrentSince Nov 1, 2002 Accepting new patients
Prisma Health University Medical Group Current Accepting new patients
Prisma Health University Medical Group CurrentSince Jan 1, 2010 Accepting new patients
Greenville Health System Past Accepting new patients
New Horizon Family Health Services Inc Past Accepting new patients

Locations

210 Freeman Farm Rd
Duncan, SC 29334
Phone (864) 968-5123

200 Patewood Dr
Ste B200
Greenville, SC 29615
Phone (864) 454-2226

877 W Faris Rd
Ste C
Greenville, SC 29605
Phone (864) 455-8147

100 Augusta St
Greenville, SC 29601
Phone (864) 455-2600

125 Halton Rd
Ste 200
Greenville, SC 29607

112B Hospital Dr
Simpsonville, SC 29681
Phone (864) 454-6850

Organizations & group practices 6

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": "1159747200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1306195200000",
    "number": "1205929965",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "P. O. BOX 8676",
            "city": "GREENVILLE",
            "state": "SC",
            "postal_code": "296048676",
            "telephone_number": "864-232-7338",
            "fax_number": "864-239-6645"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "200 PATEWOOD DR",
            "address_2": "SUITE B200",
            "city": "GREENVILLE",
            "state": "SC",
            "postal_code": "296153593",
            "telephone_number": "864-232-7338",
            "fax_number": "864-239-6645"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KIM",
        "first_name": "SUZY",
        "middle_name": "L.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-10-02",
        "last_updated": "2011-05-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207RG0100X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Gastroenterology",
            "state": "SC",
            "license": "20123",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "201230",
            "state": "SC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Greenville, SC

Sources for this page

Verify at the official NPI Registry.