Individual provider Active NPI

Jung-Ho Kim, MD

  • Internal Medicine Physician
  • Indianapolis, IN
National Provider Identifier
1366934044
Registry record updated Aug 13, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
01086420A Issued in IN
Practice address
2001 W 86TH St
Indianapolis, IN 46260
Phone
(317) 338-2345
NPI assigned
May 30, 2018
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Aug 13, 2021

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X 01086420A IN Primary

Addresses

Primary practice location

2001 W 86TH St
Indianapolis, IN 46260

Mailing address

2001 W 86TH St
Indianapolis, IN 46260-1902
Phone (317) 338-2345

Other practice location 1

4201 Saint Antoine St Ste 2E
Detroit, MI 48201-2153
Phone (734) 730-7301

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IN
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
I20210824002214 IN Practitioner - Internal Medicine 9436407384 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Internal Medicine
Education
Wayne State University School of Medicine, 2018
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

2001 W 86TH St
Indianapolis, IN 46260-1902
Phone (317) 338-2345

Hospital & facility affiliations

  • Ascension St Vincent Hospital Hospital, Indianapolis, IN, CCN 150084
  • Ascension St Vincent Kokomo Hospital, Kokomo, IN, CCN 150010

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
St Vincent Physician Services Hospital and Health Care Center Internal Medicine CurrentSince Aug 10, 2021 Accepting new patients
St Vincent Physician Services Hospital and Health Care Center CurrentSince Aug 10, 2021 Accepting new patients

Locations

2001 W 86th St
Indianapolis, IN 46260
Phone (317) 338-3617

8240 Naab Rd
Ste 100
Indianapolis, IN 46260
Phone (317) 338-7450

250 W 96th St
#520
Indianapolis, IN 46260
Phone (317) 583-3331

8050 Township Line Rd
Indianapolis, IN 46260
Phone (317) 338-2442

8240 Naab Rd
Ste 155
Indianapolis, IN 46260
Phone (317) 338-7760

Interoperability endpoints

  • Direct secure messaging: jung-ho.kim.1@13014.direct.athenahealth.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.

Hospital & facility affiliations 3

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": "1527638400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1628812800000",
    "number": "1366934044",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2001 W 86TH ST",
            "city": "INDIANAPOLIS",
            "state": "IN",
            "postal_code": "462601902",
            "telephone_number": "317-338-2345"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2001 W 86TH ST",
            "city": "INDIANAPOLIS",
            "state": "IN",
            "postal_code": "46260",
            "telephone_number": "317-338-2345"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "4201 Saint Antoine St Ste 2E",
            "address_purpose": "LOCATION",
            "city": "Detroit",
            "state": "MI",
            "postal_code": "482012153",
            "country_code": "US",
            "telephone_number": "734-730-7301",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "KIM",
        "first_name": "JUNG-HO",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2018-05-30",
        "last_updated": "2021-08-13",
        "certification_date": "2021-08-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "IN",
            "license": "01086420A",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Indianapolis, IN

Sources for this page

Verify at the official NPI Registry.