Active NPI
Soo Kim, MD
- Anesthesiology Physician
- Milwaukee, WI
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Anesthesiology Physician
- License
- 62215
- Practice address
- 9200 W Wisconsin Ave
Dept of Anesthesiology
Milwaukee, WI 53226-3522 - Phone
- (414) 805-8700
- Fax
- (414) 259-1522
- NPI assigned
- Jul 8, 2008
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Anesthesiology Physician | 207L00000X | 2012-01074 | NC | |
| Anesthesiology Physician | 207L00000X | 62215 | WI | Primary |
Addresses
Primary practice location
9200 W Wisconsin Ave
Dept of Anesthesiology
Milwaukee, WI 53226-3522
Mailing address
9200 W Wisconsin Ave
Dept of Anesthesiology
Milwaukee, WI 53226-3522
Phone (414) 805-8700
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1316100480 | Medicaid | WI |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in CO
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: Yes
Enrollment records 1
Care Compare profile
Medicare Care Compare- Specialty
- Anesthesiology
- Education
- Tufts University School of Medicine, 2008
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
Practice addresses (Care Compare)
4747 Arapahoe Ave
Boulder, CO 80303-1131
Phone (303) 415-7000
Hospital & facility affiliations
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 2012-01074 | NC | MD | Anesthesiology Physician |
| 62215 | WI | MD | Anesthesiology Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Boulder Valley Anesthesiology, PLLC | Anesthesiology | Current | Accepting new patients |
Locations
4747 Arapahoe Ave
Boulder, CO 80303
Phone (303) 415-7000
4450 Arapahoe Ave
Ste 100
Boulder, CO 80303
Phone (303) 415-2532
1100 Balsam Ave
Boulder, CO 80304
Phone (303) 415-7000
10170 Church Ranch Way
Westminster, CO 80021
Phone (303) 328-3400
Organizations & group practices 1
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.
-
- Anesthesiology Physician
- Boulder, CO
- NPI 1962431668
Hospital & facility affiliations 36
Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.
-
- Sleep Disorder Diagnostic Clinic/Center
- Boulder, CO
- NPI 1093357907
Hospital
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1215475200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1411430400000",
"number": "1316100480",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "9200 W WISCONSIN AVE",
"address_2": "DEPT OF ANESTHESIOLOGY",
"city": "MILWAUKEE",
"state": "WI",
"postal_code": "532263522",
"telephone_number": "414-805-8700",
"fax_number": "414-259-1522"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "9200 W WISCONSIN AVE",
"address_2": "DEPT OF ANESTHESIOLOGY",
"city": "MILWAUKEE",
"state": "WI",
"postal_code": "532263522",
"telephone_number": "414-805-8700",
"fax_number": "414-259-1522"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KIM",
"first_name": "SOO",
"name_prefix": "Dr.",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2008-07-08",
"last_updated": "2014-09-23",
"status": "A"
},
"taxonomies": [
{
"code": "207L00000X",
"taxonomy_group": "",
"desc": "Anesthesiology",
"state": "NC",
"license": "2012-01074",
"primary": false
},
{
"code": "207L00000X",
"taxonomy_group": "",
"desc": "Anesthesiology",
"state": "WI",
"license": "62215",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "1316100480",
"state": "WI"
}
],
"endpoints": [],
"other_names": []
}Other providers in Milwaukee, WI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 23, 2014; 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.