Active NPI
Mesun Health Services, Inc
- Skilled Nursing Facility
- Lawrenceville, GA
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Skilled Nursing Facility
- Legal business name
- MESUN HEALTH SERVICES, INC
- Practice address
- 88 Johnson Rd. Building #2
Lawrenceville, GA 30046 - Phone
- (404) 369-1907
- Fax
- (404) 369-1970
- NPI assigned
- May 26, 2020
- Organization subpart
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Mr. Eugene T Kim, M.D
- Title
- Ceo
- Phone
- (919) 599-8107
Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Skilled Nursing Facility | 314000000X | Primary |
Addresses
Primary practice location
88 Johnson Rd. Building #2
Lawrenceville, GA 30046
Mailing address
88 Johnson Rd. Building #2
Lawrenceville, GA 30046
Phone (404) 369-1907
Other names 1
- MeSun Health & Rehabilitation Center
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in GA
Enrollment records 2
Skilled nursing facility certification: CCN 115772
- Legal name
- MESUN HEALTH SERVICES INC
- Doing business as
- MESUN HEALTH AND REHABILITATION
- Certification status
- Active
- Provider type (POS)
- Nursing home – SNF/NF dual certification
- Participating since
- Jan 6, 2021
- Last certification
- Jul 18, 2024
- Beds
- 100
- Ownership / control type
- Individual
- Organization structure
- Corporation
- Enrollment address
- 88 Johnson Rd
BLDG 2
Lawrenceville, GA 30046-5520 - Nursing home name
- MESUN HEALTH AND REHABILITATION CENTER
Other NPIs with the same Medicare PAC ID 2
NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).
-
- Community Based Hospice Care Agency
- Lawrenceville, GA
- NPI 1295793446
9739190869
Care Compare: Nursing home
Medicare Care Compare- Listed as
- Mesun Health and Rehabilitation Center
- Overall star rating
- Health inspections
- Staffing
- Quality measures
- Type
- Medicare and Medicaid
- Ownership
- For profit - Individual
- Certified
- Jan 6, 2021
- Medicare certification status
- Active
- Certified beds
- 100
- Penalties (3 years)
- 2
National Provider Directory
National Provider DirectoryOwnership & related parties
All disclosed owners & managing parties 5
As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.
| Name | Role | Since | Share |
|---|---|---|---|
| Eugene T Kim | 5% Or Greater Direct Ownership Interest | Mar 28, 2022 | 100% |
| Danny Cotton | Corporate Officer | Aug 20, 2020 | |
| W-2 Managing Employee | Aug 21, 2020 | ||
| Hanson Kim | 5% Or Greater Direct Ownership Interest | Aug 20, 2020 | 100% |
| Corporate Officer | Aug 20, 2020 | 100% | |
| Sukhee Seol | Corporate Officer | Aug 22, 2020 | |
| W-2 Managing Employee | Aug 22, 2020 | ||
| Bruce Radman | W-2 Managing Employee | Aug 22, 2020 | |
| Operational/Managerial Control | Aug 22, 2020 |
Owners & managing parties with NPI records 1
Owners and managing parties disclosed on this facility’s Medicare enrollment that are themselves Medicare-enrolled.
-
- Hospice and Palliative Medicine (Family Medicine) Physician
- Douglasville, GA
- NPI 1538456843
5% Or Greater Direct Ownership Interest
Practitioners & affiliated clinicians
Practitioners 3
Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.
-
- Hospice and Palliative Medicine (Family Medicine) Physician
- Douglasville, GA
- NPI 1538456843
-
- Family Medicine Physician
- Lawrenceville, GA
- NPI 1770522476
-
- Primary Care Clinic/Center
- Braselton, GA
- NPI 1568727220
Affiliated clinicians 1
Clinicians who list this facility as an affiliation in Medicare Care Compare.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1590451200000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1590451200000",
"number": "1215550264",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "88 JOHNSON RD. BUILDING #2",
"city": "LAWRENCEVILLE",
"state": "GA",
"postal_code": "30046",
"telephone_number": "404-369-1907",
"fax_number": "404-369-1970"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "88 JOHNSON RD. BUILDING #2",
"city": "LAWRENCEVILLE",
"state": "GA",
"postal_code": "30046",
"telephone_number": "404-369-1907",
"fax_number": "404-369-1970"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "MESUN HEALTH SERVICES, INC",
"organizational_subpart": "NO",
"enumeration_date": "2020-05-26",
"last_updated": "2020-05-26",
"certification_date": "2020-05-26",
"status": "A",
"authorized_official_last_name": "KIM",
"authorized_official_first_name": "EUGENE",
"authorized_official_middle_name": "T",
"authorized_official_title_or_position": "CEO",
"authorized_official_telephone_number": "919-599-8107",
"authorized_official_name_prefix": "Mr.",
"authorized_official_credential": "M.D"
},
"taxonomies": [
{
"code": "314000000X",
"taxonomy_group": "",
"desc": "Skilled Nursing Facility",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": [
{
"organization_name": "MeSun Health & Rehabilitation Center",
"code": "3",
"type": "Doing Business As"
}
]
}
Other providers in Lawrenceville, GA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 26, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; facility enrollments, owners and changes of ownership; Provider of Services certification data.
- 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.