NPIMap

Individual provider Active NPI

Eric E. Kim, MD

  • Internal Medicine Physician
  • Clearlake, CA
National Provider Identifier
1578660916
Registry record updated Jul 8, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
A64242 Issued in CA
Practice address
4456 Manzanita Ave
Suite# C
Clearlake, CA 95422-7937
Phone
(707) 994-9191
Fax
(707) 994-9090
NPI assigned
Sep 20, 2006
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jul 8, 2010

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 A64242 CA Primary

Addresses

Primary practice location

4456 Manzanita Ave
Suite# C
Clearlake, CA 95422-7937

Mailing address

PO Box 1500
Clearlake, CA 95422-1500
Phone (707) 994-9191

Other identifiers 2

IdentifierTypeStateIssuer
00A642420MedicaidCA
2113132OtherCAMEDI-CAL UPIN #

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA
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
I20091202000616 CA Practitioner - Internal Medicine 4486793551 Reassigns benefits to 1 organization
Practice locations: Clearlake, CA

Care Compare profile

Medicare Care Compare
Specialty
Internal Medicine
Education
Loma Linda University School of Medicine, 1994
Medicare assignment
May accept Medicare assignment
Group practices

Practice addresses (Care Compare)

925 Bevins CT
Lakeport, CA 95453-9754
Phone 70726383821204

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
90.74 of 100Reported as group
Quality
94
Promoting interoperability
92
Improvement activities
40
Cost
65.12

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Lake County Tribal Health Southshore Clinic CurrentSince Oct 8, 2024 Accepting new patients
Lake County Tribal Health Consortium Inc. CurrentSince Oct 8, 2024 Accepting new patients
Dr. Wayne Ogata O.D. Inc. Past Accepting new patients
Adventist Health Clearlake Hospital, Inc Past Accepting new patients

Locations

14440 Olympic Dr
Clearlake, CA 95422
Phone (707) 263-8382

925 Bevins Ct
Lakeport, CA 95453
Phone (707) 263-8382

Interoperability endpoints

  • FHIR API: https://fhir.nextgen.com/nge/prod/fhir-api-r4/fhir/r4/
  • Direct secure messaging: eric.kim.p1@direct.lcthc.nextgenshare.com

Organizations & group practices 4

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 7

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": "1158710400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1278547200000",
    "number": "1578660916",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1500",
            "city": "CLEARLAKE",
            "state": "CA",
            "postal_code": "954221500",
            "telephone_number": "707-994-9191",
            "fax_number": "707-994-9090"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4456 MANZANITA AVE",
            "address_2": "SUITE# C",
            "city": "CLEARLAKE",
            "state": "CA",
            "postal_code": "954227937",
            "telephone_number": "707-994-9191",
            "fax_number": "707-994-9090"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KIM",
        "first_name": "ERIC",
        "middle_name": "E.",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-09-20",
        "last_updated": "2010-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "CA",
            "license": "A64242",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00A642420",
            "state": "CA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDI-CAL UPIN #",
            "identifier": "2113132",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Clearlake, CA

Sources for this page

Verify at the official NPI Registry.