Individual provider Active NPI

Phillip Kim, M.D., M.B.A.

  • Surgery Physician
  • New York, NY
National Provider Identifier
1336535202
Registry record updated Sep 3, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Surgery PhysicianTaxonomy code 208600000X
License
A158522 Issued in CA
Practice address
177 Ft Washingtn Ave # 7GS-313
New York, NY 10032-3733
Phone
(212) 305-3038
NPI assigned
Apr 7, 2015
Last updated
Sep 3, 2024By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 3, 2024

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Surgery Physician 208600000X A158522 CA Primary

Addresses

Primary practice location

177 Ft Washingtn Ave # 7GS-313
New York, NY 10032-3733

Mailing address

1290 Silas Deane Hwy
Wethersfield, CT 06109-4337
Phone (860) 972-9033

Other practice location 1

69 Jesse Hill Jr. Drive SE
Glenn Memorial Building, 3rd Floor
Atlanta, GA 30303
Phone (404) 251-8915

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in GA, CT2 enrollments
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 2

Enrollment IDStateProvider typePAC IDDetails
I20220816001385 GA Practitioner - General Surgery 6002299567 Reassigns benefits to 1 organization
I20240910001728 CT Practitioner - General Surgery 6002299567 Reassigns benefits to 4 organizations

Care Compare profile

Medicare Care Compare
Specialty
General Surgery
Education
Harvard Medical School, 2015
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Hartford HospitalGroup PAC ID 2567366016, 1,040 clinicians
Hartford Healthcare Medical Group Specialists PLLCGroup PAC ID 3173866241, 1,555 clinicians

Practice addresses (Care Compare)

80 Seymour St
Hartford, CT 06102-8000
Phone (860) 545-7500

85 Seymour St
Suite 415
Hartford, CT 06106-5523
Phone (860) 246-2071

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
90.42 of 100Reported as group
Quality
83.36
Promoting interoperability
100
Improvement activities
40
Cost
75.9

Merit-based Incentive Payment System (MIPS)

Final score
93.24 of 100Reported as group
Quality
73.72
Promoting interoperability
100
Improvement activities
40
Cost
75.22

Procedures performed for Medicare patients

ProcedureNumber of procedures
Colonoscopy1-10
Hernia repair - groin (open)1-10
Upper gastrointestinal (GI) endoscopy for acid reflux1-10
Removal of tissue1-10

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Master of Business Administration, Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
A158522CAMDSurgery Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Windham Community Memorial Hospital, Inc. CurrentSince May 15, 2025 Accepting new patients
Hartford Healthcare Medical Group Specialists, PLLC Surgery CurrentSince Oct 1, 2024 Accepting new patients
Emory Medical Care Foundation Inc Surgery CurrentSince Aug 1, 2022 Accepting new patients
Hartford Pathology Associates, P.C. Current Accepting new patients
Emory Medical Care Foundation Inc CurrentSince Aug 1, 2022 Accepting new patients
Hartford Healthcare Medical Group Specialists LLC CurrentSince Oct 1, 2024 Accepting new patients
Hartford Hospital Surgery CurrentSince Jan 4, 2025 Accepting new patients
The William W Backus Hospital CurrentSince May 15, 2025 Accepting new patients
William W Backus Hospital CurrentSince May 15, 2025 Accepting new patients
Hartford Hospital CurrentSince Jan 4, 2025 Accepting new patients

Locations

85 Seymour St
Ste 415
Hartford, CT 06106
Phone (860) 249-2071

326 Washington St
Norwich, CT 06360
Phone (860) 701-0140

1244 Storrs Rd
Storrs Mansfield, CT 06268
Phone (860) 724-2579

1290 Silas Deane Hwy
Wethersfield, CT 06109
Phone (860) 972-6977

112 Mansfield Ave
Willimantic, CT 06226
Phone (830) 423-6410

2201 Henderson Mill Rd NE
Ste 160
Atlanta, GA 30345
Phone (404) 251-2193

69 Jesse Hill Jr Dr SE
Bldg 3RD
Atlanta, GA 30303
Phone (404) 251-8915

80 Jesse Hill Jr Dr SE
Atlanta, GA 30303
Phone (404) 616-4370

Interoperability endpoints

  • Direct secure messaging: phillip.kim@xdr.hhchealthdirect.org
  • Direct secure messaging: pkim95329@connecticutchildrens.direct-ci.com

Organizations & group practices 10

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.

Hospital & facility affiliations 6

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": "1428364800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1725321600000",
    "number": "1336535202",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1290 SILAS DEANE HWY",
            "city": "WETHERSFIELD",
            "state": "CT",
            "postal_code": "061094337",
            "telephone_number": "860-972-9033"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "177 FT WASHINGTN AVE # 7GS-313",
            "city": "NEW YORK",
            "state": "NY",
            "postal_code": "100323733",
            "telephone_number": "212-305-3038"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "69 Jesse Hill Jr. Drive SE",
            "address_2": "Glenn Memorial Building, 3rd Floor",
            "address_purpose": "LOCATION",
            "city": "Atlanta",
            "state": "GA",
            "postal_code": "30303",
            "country_code": "US",
            "telephone_number": "404-251-8915",
            "fax_number": "404-523-3931",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "KIM",
        "first_name": "PHILLIP",
        "name_prefix": "Dr.",
        "credential": "M.D., M.B.A.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2015-04-07",
        "last_updated": "2024-09-03",
        "certification_date": "2024-09-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208600000X",
            "taxonomy_group": "",
            "desc": "Surgery",
            "state": "CA",
            "license": "A158522",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in New York, NY

Sources for this page

Verify at the official NPI Registry.