Ki Wan Kim, MD

Primary specialty

Thoracic Surgery (Cardiothoracic Vascular Surgery) PhysicianTaxonomy code 208G00000X

License

82757 Issued in GA

Practice address

61 Whitcher St NE Ste 4120
Marietta, GA 30060

Phone

(770) 424-9732

NPI assigned

Jan 9, 2007

Sex

Male

Sole proprietor

No

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

Specialties & licenses 3

Addresses

Electronic endpoints 1

Medicare fee-for-service enrollment

Enrolled in IL, GA2 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

Specialty

Thoracic Surgery

Education

Other, 2003

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Group practices

Wellstar Medical Group LLCGroup PAC ID 6709065402, 3,059 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Wellstar Kennestone Regional Medical Center Hospital, Marietta, GA, CCN 110035
• Wellstar Cobb Medical Center Hospital, Austell, GA, CCN 110143
• Wellstar Douglas Medical Center Hospital, Douglasville, GA, CCN 110184
• Wellstar Paulding Medical Center Hospital, Hiram, GA, CCN 110042
• Wellstar Windy Hill Hospital Long-term care hospital, Marietta, GA, CCN 112007

Merit-based Incentive Payment System (MIPS)

Final score

93.93 of 100Reported as apm

Quality

82.14

Promoting interoperability

100

Improvement activities

40

Procedures performed for Medicare patients

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: kkim339773@directwellstar.org

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.

• Wellstar Medical Group, LLC

  • Family Medicine Physician
  • Kennesaw, GA
  • NPI 1558664003
  Medicare reassignment Care Compare group NPD
• Endeavor Health Medical Group

  • Emergency Medicine Physician
  • Evanston, IL
  • NPI 1497701882
  Medicare reassignment NPD
• Wellstar Medical Group, LLC

  • Multi-Specialty Clinic/Center
  • Marietta, GA
  • NPI 1275992240
  NPD
• Endeavor Health Medical Group

  • Anesthesiology Physician
  • Evanston, IL
  • NPI 1265695944
  NPD
• Kennestone Hospital, Inc.

  • General Acute Care Hospital
  • Marietta, GA
  • NPI 1649248626
  NPD (past)

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

• Cobb Hospital, Inc

  • General Acute Care Hospital
  • Austell, GA
  • NPI 1467420448
  Care Compare affiliation
• Douglas Hospital, Inc.

  • General Acute Care Hospital
  • Douglasville, GA
  • NPI 1649247974
  Care Compare affiliation
• Kennestone Hospital, Inc.

  • General Acute Care Hospital
  • Marietta, GA
  • NPI 1649248626
  Care Compare affiliation
• Kennestone Hospital, Inc.

  • Long Term Care Hospital
  • Marietta, GA
  • NPI 1700853041

  Long-term care hospital

  Care Compare affiliation
• Paulding Medical Center, Inc.

  • General Acute Care Hospital
  • Hiram, GA
  • NPI 1457329435
  Care Compare affiliation

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

{
    "created_epoch": "1168300800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1571184000000",
    "number": "1356490734",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "61 WHITCHER ST NE STE 4120",
            "city": "MARIETTA",
            "state": "GA",
            "postal_code": "300601179",
            "telephone_number": "770-424-9732"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "61 WHITCHER ST NE STE 4120",
            "city": "MARIETTA",
            "state": "GA",
            "postal_code": "30060",
            "telephone_number": "770-424-9732"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "315 Boulevard NE Ste 500",
            "address_purpose": "LOCATION",
            "city": "Atlanta",
            "state": "GA",
            "postal_code": "30312",
            "country_code": "US",
            "telephone_number": "770-424-9732",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "2650 Ridge Ave",
            "address_2": "Walgreen Building Suite 3507",
            "address_purpose": "LOCATION",
            "city": "Evanston",
            "state": "IL",
            "postal_code": "602011718",
            "country_code": "US",
            "telephone_number": "847-570-2868",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "KIM",
        "first_name": "KI WAN",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-01-09",
        "last_updated": "2019-10-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208600000X",
            "taxonomy_group": "",
            "desc": "Surgery",
            "state": "CA",
            "license": "A90695",
            "primary": false
        },
        {
            "code": "208G00000X",
            "taxonomy_group": "",
            "desc": "Thoracic Surgery (Cardiothoracic Vascular Surgery)",
            "state": "IL",
            "license": "036127784",
            "primary": false
        },
        {
            "code": "208G00000X",
            "taxonomy_group": "",
            "desc": "Thoracic Surgery (Cardiothoracic Vascular Surgery)",
            "state": "GA",
            "license": "82757",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "kkim339773@directwellstar.org",
            "affiliation": "N",
            "address_1": "61 Whitcher St NE Ste 4120",
            "city": "Marietta",
            "state": "GA",
            "country_code": "US",
            "postal_code": "30060",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Grace S Kim, MD
• Jennifer Kim, D.M.D.
• Jessica Kim, DO
• Jihae Kim
• Joyce Kim, MD
• Minje Kim, FNP
• Seonghyeon Kim, DDS
• Stephanie Kim
• Stephen Kim, M.D.
• Kay Ann Kimball, CNP

• Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician in Marietta, GA
• Providers in Marietta, GA by specialty
• Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 16, 2019; 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.

Verify at the official NPI Registry.