You S Kim, MD

Primary specialty

Pediatrics PhysicianTaxonomy code 208000000X

License

036062285 Issued in IL

Practice address

370 Larry Power Rd
Suite 1
Bourbonnais, IL 60914-5194

Phone

(815) 937-3515

Fax

(815) 935-4916

NPI assigned

Aug 15, 2006

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Enrolled in IL

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

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

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.

• Abc Pediatrics of Kankakee County

  • Pediatrics Physician
  • Bourbonnais, IL
  • NPI 1831205194
  NPD (past) Authorized official
• Gibson Community Hospital Association

  • Critical Access Hospital
  • Gibson City, IL
  • NPI 1114935681
  NPD (past)

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

{
    "created_epoch": "1155600000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1327017600000",
    "number": "1225041445",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "370 LARRY POWER RD",
            "address_2": "SUITE 1",
            "city": "BOURBONNAIS",
            "state": "IL",
            "postal_code": "609145194",
            "telephone_number": "815-937-3515",
            "fax_number": "815-935-4916"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "370 LARRY POWER RD",
            "address_2": "SUITE 1",
            "city": "BOURBONNAIS",
            "state": "IL",
            "postal_code": "609145194",
            "telephone_number": "815-937-3515",
            "fax_number": "815-935-4916"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KIM",
        "first_name": "YOU",
        "middle_name": "S",
        "name_prefix": "Mrs.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-08-15",
        "last_updated": "2012-01-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "IL",
            "license": "036062285",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "036062285",
            "state": "IL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BC/BS",
            "identifier": "4607575",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Alicia Nicole Kendra, MSN, APRN, FNP-BC
• Peter Angelo Keorpes, PA-C
• Key Internal Medicine, S.C.
• Khan Counseling
• Kids Beyond Goals LLC
• Kinetic O & P, LTD
• Kathleen Kleinert, RD, LDN
• Chad Koch, ATC
• Koehler Sports & Spinal Rehab LTD
• Thomas D Koehler, DC CCSP

• Pediatrics Physician in Bourbonnais, IL
• Providers in Bourbonnais, IL by specialty
• Pediatrics Physician in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 20, 2012; 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.