Edward M Kim, MD

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

MD1D94799 Issued in OR

Practice address

110 Center Ave
Molalla, OR 97038-8134

Phone

(503) 829-1400

NPI assigned

May 5, 2017

Last updated

Jun 9, 2025By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Electronic endpoints 3

Medicare fee-for-service enrollment

Enrolled in OR

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

Specialty

Family Practice

Education

Medical College of Wisconsin, 2017

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Group practices

Legacy Mount Hood Medical CenterGroup PAC ID 3173515996, 58 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Legacy Mount Hood Medical Center Hospital, Gresham, OR, CCN 380025
• Legacy Good Samaritan Medical Center Hospital, Portland, OR, CCN 380017

Procedures performed for Medicare patients

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: ekim802874@oc.providencedirect.org

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.

• Legacy Mount Hood Medical Center

  dba Legacy Mount Hood Providers

  • Clinic/Center
  • Gresham, OR
  • NPI 1386919132
  Medicare reassignment Care Compare group NPD
• Providence Health & Services - Oregon

  dba Providence Willamette Falls Medical Center

  • General Acute Care Hospital
  • Oregon City, OR
  • NPI 1912282369
  Medicare reassignment NPD
• Legacy Mount Hood Medical Center

  • General Acute Care Hospital
  • Gresham, OR
  • NPI 1255354700
  NPD
• Providence Health & Services - Oregon

  dba Providence Willamette Falls Medical Center

  • Clinical Pathology Physician
  • Oregon City, OR
  • NPI 1003368911

  Family Medicine

  NPD

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

• Legacy Good Samaritan Hospital and Medical Center

  dba Legacy Good Samaritan Providers

  • Clinic/Center
  • Portland, OR
  • NPI 1679597108

  Hospital

  Care Compare affiliation
• Legacy Good Samaritan Hospital and Medical Center

  • General Acute Care Hospital
  • Portland, OR
  • NPI 1780608216
  Care Compare affiliation
• Legacy Mount Hood Medical Center

  • General Acute Care Hospital
  • Gresham, OR
  • NPI 1255354700
  Care Compare affiliation

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

{
    "created_epoch": "1493942400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1749427200000",
    "number": "1487180667",
    "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"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "110 CENTER AVE",
            "city": "MOLALLA",
            "state": "OR",
            "postal_code": "970388134",
            "telephone_number": "503-829-1400"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "4104 SE 82nd Ave",
            "address_2": "STE 250",
            "address_purpose": "LOCATION",
            "city": "Portland",
            "state": "OR",
            "postal_code": "972662954",
            "country_code": "US",
            "telephone_number": "503-215-9850",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "KIM",
        "first_name": "EDWARD",
        "middle_name": "M",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2017-05-05",
        "last_updated": "2025-06-09",
        "certification_date": "2025-06-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": "OR",
            "license": null,
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "OR",
            "license": "MD1D94799",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "ekim802874@oc.providencedirect.org",
            "affiliation": "N",
            "address_1": "110 Center Ave",
            "city": "Molalla",
            "state": "OR",
            "country_code": "US",
            "postal_code": "970388134",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "ekim802874@oc.providencedirect.org",
            "affiliation": "N",
            "address_1": "4104 SE 82nd Ave",
            "address_2": "STE 250",
            "city": "Portland",
            "state": "OR",
            "country_code": "US",
            "postal_code": "972662954",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "ekim802874@oc.providencedirect.org",
            "affiliation": "N",
            "address_1": "1500 Division St",
            "city": "Oregon City",
            "state": "OR",
            "country_code": "US",
            "postal_code": "970451527",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Frank R James, MD
• Brent A Jefferies, RPH
• Daryl L. Johnson, D.M.D.
• Dixie Lynn Johnson, LPC, NCC, OM
• JS Stafford Enterprises, Inc. (J & S Center for Wellness)
• Patrick William Kincaid, DPT
• Knead to Heal LLC (JS Massage Works)
• Julie Kornilkin, LICENSED MASSAGE THE
• Kamela Miriah Kraemer, DC
• Madison Marie Lanyon

• Family Medicine Physician in Molalla, OR
• Providers in Molalla, OR by specialty
• Family Medicine Physician in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 9, 2025; 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.