Michael Kim, OD

Primary specialty

OptometristTaxonomy code 152W00000X

License

0618002949 Issued in VA

Practice address

42015 Village Center PLZ Ste 103
Stone Ridge, VA 20105-3031

Phone

(703) 542-8888

NPI assigned

Jan 8, 2021

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in VA

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Practice roles

Locations

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.

• Jimmy Chen, OD, Inc.

  • Optometrist
  • Centreville, VA
  • NPI 1568756179
  Medicare reassignment NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1610064000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1610064000000",
    "number": "1215525829",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12640 MAGNA CARTA RD",
            "city": "HERNDON",
            "state": "VA",
            "postal_code": "201712709",
            "telephone_number": "703-579-7019"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "42015 VILLAGE CENTER PLZ STE 103",
            "city": "STONE RIDGE",
            "state": "VA",
            "postal_code": "201053031",
            "telephone_number": "703-542-8888"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KIM",
        "first_name": "MICHAEL",
        "credential": "OD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2021-01-08",
        "last_updated": "2021-01-08",
        "certification_date": "2021-01-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "VA",
            "license": "0618002949",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Hope Adult Care LLC
• Laurie Jacobs, MA CCC-SLP
• Stacy Marie Jaffe, O.D.
• Margaret Kahn, LCSW
• Mi Kim
• Erin Kathren Long, P.T., D.P.T
• Gayatri Sneh Mantha, PSYD
• Jennifer M McCormick, OTR
• Susan McCarty McCormick, MS, LMFT
• Med Urgent Care LLC

• Optometrist in Stone Ridge, VA
• Providers in Stone Ridge, VA by specialty
• Optometrist in Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 8, 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.