Individual provider Active NPI

Elizabeth S Kim, CRNA

  • Certified Registered Nurse Anesthetist
  • Fort Myers, FL
National Provider Identifier
1215076187
Registry record updated Sep 10, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Certified Registered Nurse AnesthetistTaxonomy code 367500000X
License
9211851 Issued in FL
Practice address
4048 Evans Ave
Ste 303
Fort Myers, FL 33901-9322
Phone
(239) 332-5344
Fax
(239) 332-7246
NPI assigned
Feb 6, 2007
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 10, 2019

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Certified Registered Nurse Anesthetist 367500000X 0024175572 VA
Certified Registered Nurse Anesthetist 367500000X 9211851 FL Primary

Addresses

Primary practice location

4048 Evans Ave
Ste 303
Fort Myers, FL 33901-9322

Mailing address

4048 Evans Ave
Ste 303
Fort Myers, FL 33901-9322
Phone (239) 332-5344

Other identifiers 2

IdentifierTypeStateIssuer
G4220OtherFLBSFL
AD168ZOtherFLMCR

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Certified Registered Nurse

Practice roles

OrganizationSpecialtyStatusNew patients
American Anesthesiology Associates of Georgia, LLC CurrentSince Oct 1, 2017 Accepting new patients
American Anesthesiology of Virginia, PC CurrentSince Jun 1, 2021 Accepting new patients
Outpatient Anesthesia Services of Reston, LTD CurrentSince Jul 31, 2019 Accepting new patients
Tift Regional Health System Inc. CurrentSince Dec 10, 2017 Accepting new patients
Virginia Anesthesia Services LLC CurrentSince May 25, 2021 Accepting new patients
Inova Cares - Community CurrentSince Jun 12, 2023 Accepting new patients
American Anesthesiology of Virginia PC CurrentSince Jun 1, 2021 Accepting new patients
Concordia Anesthesiology, Inc CurrentSince Aug 7, 2017 Accepting new patients
Tift Regional Health System Inc CurrentSince Dec 10, 2017 Accepting new patients
Jennifer Sassi PA Nurse Anesthetist, Certified Registered PastSince Feb 5, 2014 Accepting new patients
Medical Anesthesia and Pain Management Consultants, P.a. PastSince May 1, 2015 Accepting new patients

Locations

1500 Concord Ter
Fl 5
Sunrise, FL 33323
Phone (954) 384-0175

2701 N Decatur Rd
Decatur, GA 30033
Phone (404) 501-1000

3215 McClure Bridge Rd
Duluth, GA 30096
Phone (678) 312-6000

1000 Medical Center Blvd
Lawrenceville, GA 30046
Phone (678) 312-3356

745 Poplar Rd
Newnan, GA 30265
Phone (404) 478-8785

11650 Alpharetta Hwy
Roswell, GA 30076
Phone (770) 543-8132

901 18th St E
Tifton, GA 31794
Phone (229) 353-6208

1622 Madison Ave
Tifton, GA 31794
Phone (229) 387-8061

111 Town Square Pl
Ste 420
Jersey City, NJ 07310
Phone (201) 258-4700

3620 Joseph Siewick Dr
Ste 202
Fairfax, VA 22033
Phone (703) 766-6960

3600 Joseph Siewick Dr
Fairfax, VA 22033
Phone (703) 391-3037

3300 Gallows Rd
Falls Church, VA 22042
Phone (703) 352-9395

44045 Riverside Pkwy
Leesburg, VA 20176
Phone (703) 858-6040

1860 Town Center Dr
Ste G100
Reston, VA 20190
Phone (703) 433-8700

1806 Summit Ave
Ste 300
Richmond, VA 23230
Phone (804) 315-3771

Organizations & group practices 11

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": "1170720000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1568073600000",
    "number": "1215076187",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4048 EVANS AVE",
            "address_2": "STE 303",
            "city": "FORT MYERS",
            "state": "FL",
            "postal_code": "339019322",
            "telephone_number": "239-332-5344",
            "fax_number": "239-332-7246"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4048 EVANS AVE",
            "address_2": "STE 303",
            "city": "FORT MYERS",
            "state": "FL",
            "postal_code": "339019322",
            "telephone_number": "239-332-5344",
            "fax_number": "239-332-7246"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KIM",
        "first_name": "ELIZABETH",
        "middle_name": "S",
        "credential": "CRNA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-02-06",
        "last_updated": "2019-09-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "367500000X",
            "taxonomy_group": "",
            "desc": "Nurse Anesthetist, Certified Registered",
            "state": "VA",
            "license": "0024175572",
            "primary": false
        },
        {
            "code": "367500000X",
            "taxonomy_group": "",
            "desc": "Nurse Anesthetist, Certified Registered",
            "state": "FL",
            "license": "9211851",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BSFL",
            "identifier": "G4220",
            "state": "FL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MCR",
            "identifier": "AD168Z",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Fort Myers, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 10, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.