Active NPI
Ki-Bong Um, M.D.
- General Practice Physician
- Robersonville, NC
National Provider Identifier
1336195692
On this page
Key facts
NPPES NPI Registry- Primary specialty
- General Practice Physician
- License
- 25751
- Practice address
- 501 N Main St
Robersonville, NC 27871-9567 - Phone
- (252) 795-4192
- Fax
- (252) 795-4739
- NPI assigned
- May 26, 2006
- Last updated
- Nov 30, 2009
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| General Practice Physician | 208D00000X | 25751 | NC | Primary |
Addresses
Primary practice location
501 N Main St
Robersonville, NC 27871-9567
Mailing address
501 N Main St
PO Box 625
Robersonville, NC 27871-9567
Phone (252) 795-4192
Other identifiers 3
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 20503 | Other | NC | CIGNA |
| 84530 | Other | NC | BC |
| 8984530 | Medicaid | NC |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 25751 | NC | MD | General Practice Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Healthfirst Wellness Center, PLLC | Past | Accepting new patients | |
| Williamston Clinic Corp | Past | Accepting new patients |
Organizations & group practices 2
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.
-
- Family Nurse Practitioner
- Robersonville, NC
- NPI 1811724677
-
- Family Medicine Physician
- Williamston, NC
- NPI 1811990443
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1148601600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1259539200000",
"number": "1336195692",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "501 N MAIN ST",
"address_2": "PO BOX 625",
"city": "ROBERSONVILLE",
"state": "NC",
"postal_code": "278719567",
"telephone_number": "252-795-4192",
"fax_number": "252-795-4739"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "501 N MAIN ST",
"city": "ROBERSONVILLE",
"state": "NC",
"postal_code": "278719567",
"telephone_number": "252-795-4192",
"fax_number": "252-795-4739"
}
],
"practiceLocations": [],
"basic": {
"last_name": "UM",
"first_name": "KI-BONG",
"credential": "M.D.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2006-05-26",
"last_updated": "2009-11-30",
"status": "A"
},
"taxonomies": [
{
"code": "208D00000X",
"taxonomy_group": "",
"desc": "General Practice",
"state": "NC",
"license": "25751",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "CIGNA",
"identifier": "20503",
"state": "NC"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BC",
"identifier": "84530",
"state": "NC"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "8984530",
"state": "NC"
}
],
"endpoints": [],
"other_names": []
}Other providers in Robersonville, NC
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 30, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.