NPIMap

Individual provider Active NPI

Andrew Kim, PT

  • Physical Therapist
  • Renton, WA
National Provider Identifier
1386143360
Registry record updated Mar 26, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
License
60822073 Issued in WA
Practice address
14028 SE Petrovitsky Rd
Renton, WA 98058-8933
Phone
(425) 272-0252
Fax
(425) 272-0291
NPI assigned
Feb 6, 2018
Last updated
Mar 26, 2018By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 26, 2018

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Therapist 225100000X 60822073 WA Primary

Addresses

Primary practice location

14028 SE Petrovitsky Rd
Renton, WA 98058-8933

Mailing address

16083 SW Upper Boones Ferry Rd Ste 300
Tigard, OR 97224-7736
Phone (800) 219-8835

Other identifiers 1

IdentifierTypeStateIssuer
2096298MedicaidWA

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WA, DC, MD3 enrollments

Enrollment records 3

Enrollment IDStateProvider typePAC IDDetails
I20180301002496 WA Practitioner - Physical Therapist in Private Practice 8729349048 Reassigns benefits to 3 organizations
I20210630000475 DC Practitioner - Physical Therapist in Private Practice 8729349048 Reassigns benefits to 1 organization
I20210630000549 MD Practitioner - Physical Therapist in Private Practice 8729349048 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physical Therapist in Private Practice
Education
Other, 2018
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Washington Luna Care Physical Therapy LLCGroup PAC ID 7416283817, 161 clinicians

Practice addresses (Care Compare)

Bellevue, WA 98006
Phone (866) 525-3175

Merit-based Incentive Payment System (MIPS)

Final score
85.56 of 100Reported as group
Quality
89.84
Improvement activities
40
Cost
70.51

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
28484MDMDSocial Worker
60822073WAMDPhysical Therapist

Practice roles

OrganizationSpecialtyStatusNew patients
Maryland Sportscare & Rehab LLC Physical Therapist CurrentSince Jun 15, 2021 Accepting new patients
Maryland Sportscare & Rehab, LLC Physical Therapist CurrentSince Jun 15, 2021 Accepting new patients
Empowerme Rehabilitation Wa, PC Physical Therapist CurrentSince Sep 19, 2023 Accepting new patients
Therapeutic Associates Inc Physical Therapist Past Accepting new patients
Integrated Joint Specialists LLC Past Accepting new patients
Therapeutic Associates Inc Physical Therapist PastSince Jan 31, 2018 Accepting new patients
Therapeutic Associates Inc Physical Therapist Past Accepting new patients

Locations

9815 Main St
Ste 206
Damascus, MD 20872
Phone (301) 253-6761

141 Thomas Johnson Dr
Ste 180
Frederick, MD 21702
Phone (301) 620-7478

25 Main St
Ste A
Reisterstown, MD 21136
Phone (410) 833-8300

1335 Strassner Dr
Saint Louis, MO 63144
Phone (314) 673-6723

4503 S Freya St
Spokane, WA 99223
Phone (509) 472-8752

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.

NPI Registry JSON

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

{
    "created_epoch": "1517875200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1522022400000",
    "number": "1386143360",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "16083 SW UPPER BOONES FERRY RD STE 300",
            "city": "TIGARD",
            "state": "OR",
            "postal_code": "972247736",
            "telephone_number": "800-219-8835",
            "fax_number": "503-639-9699"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "14028 SE PETROVITSKY RD",
            "city": "RENTON",
            "state": "WA",
            "postal_code": "980588933",
            "telephone_number": "425-272-0252",
            "fax_number": "425-272-0291"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KIM",
        "first_name": "ANDREW",
        "credential": "PT",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2018-02-06",
        "last_updated": "2018-03-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "WA",
            "license": "60822073",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2096298",
            "state": "WA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Renton, WA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 26, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • 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.