NPIMap

Individual provider Active NPI

Edward Kim, MD

  • Cardiovascular Disease Physician
  • Lewiston, ID
National Provider Identifier
1386752913
Registry record updated Dec 27, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Cardiovascular Disease PhysicianTaxonomy code 207RC0000X
License
M-15510 Issued in ID
Practice address
415 6TH St
Lewiston, ID 83501-2431
Phone
(208) 750-7507
Fax
(208) 750-7384
NPI assigned
Aug 25, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 27, 2024

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Cardiovascular Disease Physician 207RC0000X 39929 WA
Cardiovascular Disease Physician 207RC0000X M-15510 ID Primary

Addresses

Primary practice location

415 6TH St
Lewiston, ID 83501-2431

Mailing address

415 6TH St
Lewiston, ID 83501-2431
Phone (208) 750-7507

Other identifiers 2

IdentifierTypeStateIssuer
1386752913MedicaidID
BK 5346970MedicaidWA

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WA, ID2 enrollments
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20090212000708 WA Practitioner - Interventional CardiologyPractitioner - Cardiovascular Disease (Cardiology) 0345288916 Reassigns benefits to 3 organizations
I20201216003017 ID Practitioner - Cardiovascular Disease (Cardiology)Practitioner - Interventional Cardiology 0345288916 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Cardiovascular Disease (Cardiology)Also: Interventional Cardiology
Education
Perelman School of Med at the University of Pennsylvania, 1993
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
St Joseph Hospital LLCGroup PAC ID 8325325806, 91 clinicians

Practice addresses (Care Compare)

415 6TH St
Lewiston, ID 83501-2431
Phone (208) 743-2511

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Coronary angioplasty and stenting75
Pacemaker insertion or repair49

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
M-15510IDMDCardiovascular Disease Physician
39929WAMDCardiovascular Disease Physician

Practice roles

OrganizationSpecialtyStatusNew patients
King County Public Hospital District No. 2 Cardiovascular Disease CurrentSince Jul 1, 2001 Accepting new patients
King County Public Hospital District No 2 Current Accepting new patients
RCCH Trios Health LLC CurrentSince Mar 24, 2020 Accepting new patients
St Joseph Hospital LLC CurrentSince Dec 1, 2020 Accepting new patients
King County Public Hospital District No. 2 CurrentSince Jul 1, 2001 Accepting new patients
Grays Harbor Community Hospital CurrentSince Nov 9, 2020 Accepting new patients
GHCH Physician Services, LLC Cardiovascular Disease CurrentSince Nov 9, 2020 Accepting new patients
King County Public Hospital District No 2 Past Accepting new patients
St. Joseph Hospital LLC Past Accepting new patients
King County Public Hospital District No 2 Past Accepting new patients

Locations

821 21st Ave
Lewiston, ID 83501
Phone (208) 799-3422

341 Saint Johns Way
Lewiston, ID 83501
Phone (208) 750-7462

415 6th St
Lewiston, ID 83501
Phone (208) 750-7445

1211 Skyview Dr
Aberdeen, WA 98520
Phone (360) 532-3808

14720 Main St NE
Ste 109
Duvall, WA 98019
Phone (425) 788-4889

216 W 10th Ave
Ste 204
Kennewick, WA 99336
Phone (509) 221-5520

3730 Plaza Way
Kennewick, WA 99338
Phone (509) 221-6350

12040 NE 128th St
#50
Kirkland, WA 98034
Phone (425) 899-1894

12333 NE 130th Ln
Ste 320
Kirkland, WA 98034
Phone (206) 899-0555

12040 NE 128th St
Kirkland, WA 98034
Phone (425) 899-1000

12303 NE 130th Ln
Ste 225
Kirkland, WA 98034
Phone (425) 899-3890

319 E Pioneer Ave
Montesano, WA 98563
Phone (360) 249-1980

1959 NE Pacific St
Seattle, WA 98195
Phone (206) 598-4333

Interoperability endpoints

  • Direct secure messaging: edward.kim@direct.vmmc.org
  • Direct secure messaging: edward.kim.1@16883.direct.athenahealth.com

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 and National Provider Directory roles.

Hospital & facility affiliations 16

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

View all 16

NPI Registry JSON

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

{
    "created_epoch": "1156464000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1735257600000",
    "number": "1386752913",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "415 6TH ST",
            "city": "LEWISTON",
            "state": "ID",
            "postal_code": "835012431",
            "telephone_number": "208-750-7507",
            "fax_number": "208-750-7384"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "415 6TH ST",
            "city": "LEWISTON",
            "state": "ID",
            "postal_code": "835012431",
            "telephone_number": "208-750-7507",
            "fax_number": "208-750-7384"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KIM",
        "first_name": "EDWARD",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-08-25",
        "last_updated": "2024-12-27",
        "certification_date": "2024-12-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207RC0000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Cardiovascular Disease",
            "state": "WA",
            "license": "39929",
            "primary": false
        },
        {
            "code": "207RC0000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Cardiovascular Disease",
            "state": "ID",
            "license": "M-15510",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1386752913",
            "state": "ID"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "BK 5346970",
            "state": "WA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Lewiston, ID

Sources for this page

Verify at the official NPI Registry.