NPIMap

Individual provider Active NPI

Su Gym Kim, M.D.

  • Interventional Pain Medicine Physician
  • Providence, RI
National Provider Identifier
1235418369
Registry record updated Oct 26, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Interventional Pain Medicine PhysicianTaxonomy code 208VP0014X
License
MD15614 Issued in RI
Practice address
593 Eddy St
George Building, First Floor
Providence, RI 02903-4923
Phone
(401) 444-3777
Fax
(401) 444-7249
NPI assigned
Aug 7, 2011
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 26, 2021

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Interventional Pain Medicine Physician 208VP0014X 46722 KY
Interventional Pain Medicine Physician 208VP0014X MD15614 RI Primary

Addresses

Primary practice location

593 Eddy St
George Building, First Floor
Providence, RI 02903-4923

Mailing address

117 Ellenfield St
Suite 101
Providence, RI 02905-4513
Phone (401) 444-6779

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address skim418102@direct.stfranciscare.org Direct

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in RI, CT2 enrollments
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20170117001481 RI Practitioner - Interventional Pain ManagementPractitioner - Pain Management 5395969943 Reassigns benefits to 1 organization
I20190207002162 CT Practitioner - Physical Medicine and Rehabilitation 5395969943 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physical Medicine and Rehabilitation
Education
Other, 2004
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

490 Blue Hills Ave
Hartford, CT 06112-1513
Phone (860) 714-3500

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
MD15614RIMDInterventional Pain Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Rhode Island Hospital CurrentSince Jan 16, 2017 Accepting new patients
Trinity Health of New England Provider Network Organization Inc CurrentSince Feb 25, 2019 Accepting new patients
Rhode Island Hospital CurrentSince Jan 16, 2017 Accepting new patients
Trinity Health of New England Provider Network Organization Inc CurrentSince Feb 25, 2019 Accepting new patients
Rhode Island Hospital Past Accepting new patients

Locations

1300 Hall Blvd
Fl 3
Bloomfield, CT 06002
Phone (860) 714-2376

148 Hazard Ave
Enfield, CT 06082
Phone (413) 567-6860

140 Hazard Ave
Ste 105
Enfield, CT 06082
Phone (860) 272-2930

114 Woodland St
Hartford, CT 06105
Phone (860) 714-4001

476 Cromwell Ave
Rocky Hill, CT 06067
Phone (860) 696-6400

1454 S County Trl
Ste 2100
East Greenwich, RI 02818
Phone (401) 606-2000

593 Eddy St
Bldg First
Providence, RI 02903
Phone (401) 444-3777

593 Eddy St
#921
Providence, RI 02903
Phone (401) 444-3250

593 Eddy St
Providence, RI 02903

117 Ellenfield St
Ste 101
Providence, RI 02905
Phone (401) 444-4318

593 Eddy St
Ste 9B
Providence, RI 02903
Phone (401) 444-5280

Interoperability endpoints

  • Direct secure messaging: skim2389207@direct.trinity-health.org

Organizations & group practices 5

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.

Hospital & facility affiliations 9

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

NPI Registry JSON

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

{
    "created_epoch": "1312675200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1635206400000",
    "number": "1235418369",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "117 ELLENFIELD ST",
            "address_2": "SUITE 101",
            "city": "PROVIDENCE",
            "state": "RI",
            "postal_code": "029054513",
            "telephone_number": "401-444-6779",
            "fax_number": "401-444-6912"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "593 EDDY ST",
            "address_2": "GEORGE BUILDING, FIRST FLOOR",
            "city": "PROVIDENCE",
            "state": "RI",
            "postal_code": "029034923",
            "telephone_number": "401-444-3777",
            "fax_number": "401-444-7249"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KIM",
        "first_name": "SU GYM",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2011-08-07",
        "last_updated": "2021-10-26",
        "certification_date": "2021-10-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208VP0014X",
            "taxonomy_group": "",
            "desc": "Pain Medicine, Interventional Pain Medicine",
            "state": "KY",
            "license": "46722",
            "primary": false
        },
        {
            "code": "208VP0014X",
            "taxonomy_group": "",
            "desc": "Pain Medicine, Interventional Pain Medicine",
            "state": "RI",
            "license": "MD15614",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "skim418102@direct.stfranciscare.org",
            "affiliation": "N",
            "endpointDescription": "CT Direct email address",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "CCD",
            "address_1": "490 Blue Hills Ave",
            "city": "Hartford",
            "state": "CT",
            "country_code": "US",
            "postal_code": "06112",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Providence, RI

Sources for this page

Verify at the official NPI Registry.