NPIMap

Individual provider Active NPI

Ina Kim, MD

  • Urology Physician
  • Roseville, CA
National Provider Identifier
1295909455
Registry record updated Jul 21, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Urology PhysicianTaxonomy code 208800000X
License
A148685 Issued in CA
Practice address
3 Medical Plaza Dr Ste 250
Roseville, CA 95661-3089
Phone
(916) 797-4720
Fax
(916) 797-4721
NPI assigned
Apr 18, 2008
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 21, 2022

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Student in an Organized Health Care Education/Training Program 390200000X
Urology Physician 208800000X 28226 NE
Urology Physician 208800000X A148685 CA Primary

Addresses

Primary practice location

3 Medical Plaza Dr Ste 250
Roseville, CA 95661-3089

Mailing address

10470 Old Placerville Rd Ste 100
Sacramento, CA 95827-2539
Phone (800) 470-0071

Other practice location 1

988102 Nebraska Medical Ctr
Omaha, NE 68198-8102
Phone (402) 559-4292

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NE, CA2 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
I20141224000112 NE Practitioner - UrologyPractitioner - General Surgery 2961725957 Reassigns benefits to 1 organization
I20170816003654 CA Practitioner - Urology 2961725957 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Urology
Education
Baylor College of Medicine, 2008
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Sutter Valley Medical FoundationGroup PAC ID 9830094515, 2,473 clinicians

Practice addresses (Care Compare)

1 Medical Plaza Dr
Roseville, CA 95661-3037
Phone (916) 454-6868

2800 L St
Sacramento, CA 95816-5616

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Prostate resection15

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
A148685CAMDUrology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Unmc Physicians CurrentSince Jan 1, 2015 Accepting new patients
Sutter Valley Medical Foundation Urology CurrentSince May 1, 2019 Accepting new patients
Sutter Valley Medical Foundation CurrentSince May 1, 2019 Accepting new patients
Sutter Valley Medical Foundation Urology Current Accepting new patients
Sutter North Medical Foundation Past Accepting new patients
Nebraska Medical Center Past Accepting new patients

Locations

3 Medical Plaza Dr
Ste 250
Roseville, CA 95661
Phone (916) 773-8757

10470 Old Placerville Rd
Ste 100
Sacramento, CA 95827

2750 Gateway Oaks Dr
Ste 150
Sacramento, CA 95833
Phone (916) 887-7398

2800 L St
Ste 500
Sacramento, CA 95816
Phone (916) 454-6850

Emile 42nd St
Omaha, NE 68198
Phone (402) 552-6731

988102 Nebraska Medical Ctr
Omaha, NE 68198
Phone (402) 559-5600

Interoperability endpoints

  • Direct secure messaging: ikim370212@hisp.ehr.sutterhealth.org

Organizations & group practices 6

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 4

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": "1208476800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1658361600000",
    "number": "1295909455",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10470 OLD PLACERVILLE RD STE 100",
            "city": "SACRAMENTO",
            "state": "CA",
            "postal_code": "958272539",
            "telephone_number": "800-470-0071"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3 MEDICAL PLAZA DR STE 250",
            "city": "ROSEVILLE",
            "state": "CA",
            "postal_code": "956613089",
            "telephone_number": "916-797-4720",
            "fax_number": "916-797-4721"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "988102 Nebraska Medical Ctr",
            "address_purpose": "LOCATION",
            "city": "Omaha",
            "state": "NE",
            "postal_code": "681988102",
            "country_code": "US",
            "telephone_number": "402-559-4292",
            "fax_number": "402-559-6529",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "KIM",
        "first_name": "INA",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2008-04-18",
        "last_updated": "2022-07-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "208800000X",
            "taxonomy_group": "",
            "desc": "Urology",
            "state": "NE",
            "license": "28226",
            "primary": false
        },
        {
            "code": "208800000X",
            "taxonomy_group": "",
            "desc": "Urology",
            "state": "CA",
            "license": "A148685",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Roseville, CA

Sources for this page

Verify at the official NPI Registry.