NPIMap

Individual provider Active NPI

Andrew D Kim, MD

  • Internal Medicine Physician
  • Medford, OR
National Provider Identifier
1376639245
Registry record updated May 3, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
MD22848 Issued in OR
Practice address
965 Ellendale Dr
Medford, OR 97504-8215
Phone
(541) 732-6000
Fax
(541) 732-6005
NPI assigned
Oct 5, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 3, 2022

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 MD22848 OR Primary

Addresses

Primary practice location

965 Ellendale Dr
Medford, OR 97504-8215

Mailing address

PO Box 3158
Portland, OR 97208-3158
Phone (503) 215-6494

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address akim139775@oc.providencedirect.org

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OR
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20100202000862 OR Practitioner - Internal Medicine 6709929540 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Internal Medicine
Education
University of California, Geffen School of Medicine, 1992
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Providence Health and Services OregonGroup PAC ID 5294623245, 166 clinicians

Practice addresses (Care Compare)

965 Ellendale Dr
Medford, OR 97504-8215
Phone (541) 732-6000

Hospital & facility affiliations

  • Providence Medford Home Care Home health agency, Medford, OR, CCN 387016
  • Accentcare Home Health of Rogue Valley, LLC Home health agency, Medford, OR, CCN 387098
  • Riverside Home Health Care Home health agency, Grants Pass, OR, CCN 387143
  • Assured Home Health Home health agency, Grants Pass, OR, CCN 387076
  • Providence Medford Hospice Hospice, Medford, OR, CCN 381506
  • Providence Medford Medical Center Hospital, Medford, OR, CCN 380075
  • Asante Rogue Regional Medical Center Hospital, Medford, OR, CCN 380018
  • Asante Three Rivers Medical Center Hospital, Grants Pass, OR, CCN 380002
  • Asante Ashland Community Hospital Hospital, Ashland, OR, CCN 380005

Procedures performed for Medicare patients

ProcedureNumber of procedures
Removal of skin lesions1-10

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Providence Health & Services - Oregon CurrentSince Jan 22, 2001 Accepting new patients
Providence Health & Services Oregon CurrentSince Jan 22, 2001 Accepting new patients
Providence Health & Services - Oregon Internal Medicine CurrentSince May 21, 2018 Accepting new patients
Providence Health & Services - Oregon Current Accepting new patients
Providence Health & Services Oregon Internal Medicine Current Accepting new patients
Providence Health & Services - Oregon Internal Medicine CurrentSince May 21, 2018 Accepting new patients

Locations

940 Royal Ave
Unit 350
Medford, OR 97504
Phone (541) 732-7460

965 Ellendale Dr
Medford, OR 97504
Phone (541) 732-6000

1111 Crater Lake Ave
Medford, OR 97504
Phone (541) 732-5250

1698 E McAndrews Rd
Ste 400
Medford, OR 97504
Phone (541) 732-6000

Organizations & group practices 6

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 9

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": "1160006400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1651536000000",
    "number": "1376639245",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 3158",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972083158",
            "telephone_number": "503-215-6494",
            "fax_number": "503-215-6644"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "965 ELLENDALE DR",
            "city": "MEDFORD",
            "state": "OR",
            "postal_code": "975048215",
            "telephone_number": "541-732-6000",
            "fax_number": "541-732-6005"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KIM",
        "first_name": "ANDREW",
        "middle_name": "D",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-10-05",
        "last_updated": "2022-05-03",
        "certification_date": "2022-05-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "OR",
            "license": "MD22848",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "akim139775@oc.providencedirect.org",
            "affiliation": "N",
            "address_1": "965 Ellendale Dr",
            "city": "Medford",
            "state": "OR",
            "country_code": "US",
            "postal_code": "975048215",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Medford, OR

Sources for this page

Verify at the official NPI Registry.