Ellen Kim, MD

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

97-289 Issued in NM

Practice address

7500 Jefferson St NE Ste 210
Albuquerque, NM 87109-4384

Phone

(505) 821-5404

NPI assigned

Nov 29, 2006

Last updated

Jan 19, 2023By the provider in NPPES

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

Medicare fee-for-service enrollment

Enrolled in NM

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

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Gray Pearls LLC

  • Geriatric Medicine (Family Medicine) Physician
  • Albuquerque, NM
  • NPI 1932562360
  Authorized official Same address or phone
• Southwest Neuropsychology and Behavioral Health, LLC

  • Clinical Neuropsychologist
  • Albuquerque, NM
  • NPI 1023315017
  NPD
• Spine Clinic of Monterey Bay

  • Orthopaedic Surgery of the Spine Physician
  • Soquel, CA
  • NPI 1558436865

  Family Medicine

  NPD (past)

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

{
    "created_epoch": "1164758400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1674086400000",
    "number": "1275600637",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "908 GRECIAN AVE NW",
            "city": "ALBUQUERQUE",
            "state": "NM",
            "postal_code": "871075733",
            "telephone_number": "505-506-1984"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7500 JEFFERSON ST NE STE 210",
            "city": "ALBUQUERQUE",
            "state": "NM",
            "postal_code": "871094384",
            "telephone_number": "505-821-5404"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KIM",
        "first_name": "ELLEN",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-11-29",
        "last_updated": "2023-01-19",
        "certification_date": "2023-01-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "NM",
            "license": "97-289",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Richmond Kilpatrick, DPM
• Kim Smith PHD Inc
• Alexander Ivan Kim, M.D.
• Charles B Kim, MD
• Chris Y. Kim, DDS
• Elly Bunsun Kim, D.D.S.
• Gina Kim
• Gloria Kim
• Hyuna Kim
• Hyunnarm Kim, D.O.

• Family Medicine Physician in Albuquerque, NM
• Providers in Albuquerque, NM by specialty
• Family Medicine Physician in New Mexico

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 19, 2023; 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.