Individual provider Active NPI

Anthony Kim, M.D.

  • Family Medicine Physician
  • Fort Worth, TX
National Provider Identifier
1356311823
Registry record updated Feb 23, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
K8925 Issued in TX
Practice address
4701 Boat Club Rd., Suite 200
Fort Worth, TX 76135-5285
Phone
(817) 237-0515
NPI assigned
Jan 25, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 23, 2022

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X K8925 TX Primary

Addresses

Primary practice location

4701 Boat Club Rd., Suite 200
Fort Worth, TX 76135-5285

Mailing address

4701 Boat Club Rd., Suite 200
Fort Worth, TX 76135-5285
Phone (817) 237-0515

Other identifiers 1

IdentifierTypeStateIssuer
149986502MedicaidTX

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address akim18869@Direct.TexasHealt.org Health Information Exchange (HIE)

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
I20040618001047 TX Practitioner - Family Practice 3678558251 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
University of Texas Medical School at San Antonio, 1998
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Texas Health Physicians GroupGroup PAC ID 4385535954, 1,364 clinicians

Practice addresses (Care Compare)

4701 Boat Club Rd
Suite 200
Fort Worth, TX 76135-5285
Phone (817) 237-0515

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
K8925TXMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Texas Health Physicians Group CurrentSince Jun 1, 2010 Accepting new patients
Texas Health Physicians Group Family Medicine CurrentSince Jun 1, 2010 Accepting new patients
Texas Health Physicians Group Current Accepting new patients

Locations

1600 Hospital Pkwy
Bedford, TX 76022
Phone (817) 355-7803

4701 Boat Club Rd
Ste 125
Fort Worth, TX 76135
Phone (817) 237-0515

4504 Boat Club Rd
Ste 800
Ft Worth, TX 76135
Phone (817) 237-0515

4701 Boat Club Rd
Ste 200
Ft Worth, TX 76135
Phone (817) 237-0515

Interoperability endpoints

  • Direct secure messaging: akim18869@direct.texashealt.org
  • Direct secure messaging: akim18869@direct.texashealth.org

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.

Hospital & facility affiliations 5

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": "1138147200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1645574400000",
    "number": "1356311823",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4701 BOAT CLUB RD., SUITE 200",
            "city": "FORT WORTH",
            "state": "TX",
            "postal_code": "761355285",
            "telephone_number": "817-237-0515"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4701 BOAT CLUB RD., SUITE 200",
            "city": "FORT WORTH",
            "state": "TX",
            "postal_code": "761355285",
            "telephone_number": "817-237-0515"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KIM",
        "first_name": "ANTHONY",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-01-25",
        "last_updated": "2022-02-23",
        "certification_date": "2022-02-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "TX",
            "license": "K8925",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "149986502",
            "state": "TX"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "akim18869@Direct.TexasHealt.org",
            "affiliation": "N",
            "endpointDescription": "Health Information Exchange",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "address_1": "4701 Boat Club Rd., Suite 200",
            "city": "Fort Worth",
            "state": "TX",
            "country_code": "US",
            "postal_code": "761355285",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Fort Worth, TX

Sources for this page

Verify at the official NPI Registry.