Individual provider Active NPI

Young H Shim, MD

  • Pediatric Emergency Medicine (Pediatrics) Physician
  • Fort Worth, TX
National Provider Identifier
1316236052
Registry record updated Jul 1, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatric Emergency Medicine (Pediatrics) PhysicianTaxonomy code 2080P0204X
License
P9959 Issued in TX
Practice address
801 7TH Ave
Fort Worth, TX 76104-2733
Phone
(682) 885-4095
NPI assigned
Apr 4, 2011
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 1, 2024

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatric Emergency Medicine (Emergency Medicine) Physician 207PP0204X P9959 TX
Pediatric Emergency Medicine (Pediatrics) Physician 2080P0204X P9959 TX Primary
Pediatrics Physician 208000000X P9959 TX

Addresses

Primary practice location

801 7TH Ave
Fort Worth, TX 76104-2733

Mailing address

PO Box 733784
Dallas, TX 75373-3784
Phone (682) 885-1860

Other names 1

  • Noah Shim Other name

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address yshim16975@CookChildrens.direct-ci.com

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TX
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

Enrollment IDStateProvider typePAC IDDetails
I20170621000420 TX Practitioner - Pediatric MedicinePractitioner - Emergency Medicine 9436427168 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Pediatric MedicineAlso: Emergency Medicine
Education
Medical College of Georgia School of Medicine, 2011
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Cook Childrens Physician NetworkGroup PAC ID 7719884584, 307 clinicians

Practice addresses (Care Compare)

4100 W University Dr
Prosper, TX 75078-3123
Phone (945) 204-4100

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
P9959TXMDPediatric Emergency Medicine (Pediatrics) Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Cook Children'S Physician Network Pediatrics CurrentSince Jul 24, 2017 Accepting new patients
Cook Children'S Physician Network Pediatrics CurrentSince Jul 24, 2017 Accepting new patients
Cook Children'S Medical Center Past Accepting new patients

Locations

801 7th Ave
Ft Worth, TX 76104
Phone (682) 885-4054

6316 Precinct Line Rd
Hurst, TX 76054
Phone (817) 605-2500

4100 W University Dr
Prosper, TX 75078
Phone (682) 303-4200

Interoperability endpoints

  • Direct secure messaging: yshim16975@cookchildrens.direct-ci.com

Organizations & group practices 3

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.

NPI Registry JSON

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

{
    "created_epoch": "1301875200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1719792000000",
    "number": "1316236052",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 733784",
            "city": "DALLAS",
            "state": "TX",
            "postal_code": "753733784",
            "telephone_number": "682-885-1860",
            "fax_number": "682-885-1396"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "801 7TH AVE",
            "city": "FORT WORTH",
            "state": "TX",
            "postal_code": "761042733",
            "telephone_number": "682-885-4095"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SHIM",
        "first_name": "YOUNG",
        "middle_name": "H",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2011-04-04",
        "last_updated": "2024-07-01",
        "certification_date": "2024-07-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207PP0204X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine, Pediatric Emergency Medicine",
            "state": "TX",
            "license": "P9959",
            "primary": false
        },
        {
            "code": "2080P0204X",
            "taxonomy_group": "",
            "desc": "Pediatrics, Pediatric Emergency Medicine",
            "state": "TX",
            "license": "P9959",
            "primary": true
        },
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "TX",
            "license": "P9959",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "yshim16975@CookChildrens.direct-ci.com",
            "affiliation": "N",
            "address_1": "801 7th Ave",
            "city": "Fort Worth",
            "state": "TX",
            "country_code": "US",
            "postal_code": "761042733",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "first_name": "NOAH",
            "last_name": "SHIM",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Fort Worth, TX

Sources for this page

Verify at the official NPI Registry.