Charles Chol Bae Kim, MD

Primary specialty

Adult Medicine PhysicianTaxonomy code 207QA0505X

License

C129160 Issued in CA

Practice address

14642 Newport Ave Ste 105
Tustin, CA 92780-6058

Phone

(714) 831-1112

Fax

(714) 486-2309

NPI assigned

May 3, 2017

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 3

Addresses

Medicare fee-for-service enrollment

Enrolled in CA, AZ2 enrollments

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 2

Specialty

Family PracticeAlso: Internal Medicine

Education

Other, 1981

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Humane Medical GroupGroup PAC ID 1254862634, 2 clinicians

Inland Behavioral and Health Services IncGroup PAC ID 2769392927, shared by 2 NPIs, 10 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Select Care Home Health Services Inc Home health agency, Los Angeles, CA, CCN 058219
• Excellent Care Home Health Services, Inc Home health agency, Chino, CA, CCN 058183
• Rafaella Hospice, Inc Hospice, Los Angeles, CA, CCN A01583

Merit-based Incentive Payment System (MIPS)

Final score

75 of 100Reported as individual

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

Networks

• BSC 65 PLUS INDIVIDUAL MAPD

Interoperability endpoints

• Direct secure messaging: charles.kim.p1@direct.cdsdp.nextgenshare.com

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.

• Humane Medical Group

  • Internal Medicine Physician
  • Los Angeles, CA
  • NPI 1164251633

  Multi-Specialty

  Medicare reassignment Care Compare group NPD
• La Paz Regional Hospital Inc

  • Critical Access Hospital
  • Parker, AZ
  • NPI 1053684555

  Multi-Specialty

  Medicare reassignment NPD
• Wound Masters Medical Group Inc

  • Surgery Physician
  • Ontario, CA
  • NPI 1376063461

  AZ

  Medicare reassignment
• Charles Kim MD Inc

  • Geriatric Medicine (Family Medicine) Physician
  • Tustin, CA
  • NPI 1063050193

  Multi-Specialty

  NPD
• E Globaltelecare Inc

  • General Practice Physician
  • Garden Grove, CA
  • NPI 1841026259

  Multi-Specialty

  NPD
• La Paz Regional Hospital Inc

  • Urgent Care Clinic/Center
  • Parker, AZ
  • NPI 1598009029
  NPD
• La Paz Regional Hospital Inc

  • Medicare Defined Swing Bed Hospital Unit
  • Parker, AZ
  • NPI 1598038093
  NPD

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

• Excellent Care Home Health Services, Inc.

  • Home Health Agency
  • Chino, CA
  • NPI 1881678217
  Care Compare affiliation
• Select Care Home Health Services, Inc.

  • Home Health Agency
  • Los Angeles, CA
  • NPI 1205835873
  Care Compare affiliation

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

{
    "created_epoch": "1493769600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1634083200000",
    "number": "1225564818",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1200 W MOHAVE RD",
            "city": "PARKER",
            "state": "AZ",
            "postal_code": "853446349",
            "telephone_number": "928-669-7380"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "14642 NEWPORT AVE STE 105",
            "city": "TUSTIN",
            "state": "CA",
            "postal_code": "927806058",
            "telephone_number": "714-831-1112",
            "fax_number": "714-486-2309"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KIM",
        "first_name": "CHARLES CHOL BAE",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2017-05-03",
        "last_updated": "2021-10-13",
        "certification_date": "2021-10-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": "AZ",
            "license": "54481",
            "primary": false
        },
        {
            "code": "207QG0300X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine, Geriatric Medicine",
            "state": "CA",
            "license": "C-129160",
            "primary": false
        },
        {
            "code": "207QA0505X",
            "taxonomy_group": "",
            "desc": "Family Medicine, Adult Medicine",
            "state": "CA",
            "license": "C129160",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Lakshmi Keerthana Killampalli
• Monique Kim-Nomura
• Bernard Kim, DC, BSC
• Brian Kim, DDS
• Brian Byoungsoo Kim, MPT
• David Sang Pum Kim, MD
• Dio D Kim, D.C., L. AC.
• Grace Kim, PHARMD
• Gwyneth Kim, FNP
• Hailey Kim

• Adult Medicine Physician in Tustin, CA
• Providers in Tustin, CA by specialty
• Adult Medicine Physician in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 13, 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.
• 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.

Verify at the official NPI Registry.