Active NPI
Jae Hyun Kim, MD
- Student in an Organized Health Care Education/Training Program
- Lutz, FL
National Provider Identifier
1619670387
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Student in an Organized Health Care Education/Training Program
- Practice address
- 21808 State Road 54
Lutz, FL 33549-6923 - Phone
- (813) 922-8621
- NPI assigned
- Mar 22, 2023
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Student in an Organized Health Care Education/Training Program | 390200000X | Primary |
Addresses
Primary practice location
21808 State Road 54
Lutz, FL 33549-6923
Mailing address
2995 Drew St
Clearwater, FL 33759-3012
Phone (727) 315-7496
Electronic endpoints 1
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| Direct Messaging Address | jae.kimmd@direct.mybaycare.org | Health Information Exchange (HIE) | BayCare Behavioral Health Associates LLC |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in FL
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: Yes
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20230914004131 | FL | Order and Referring Only - Psychiatry | 0042674632 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
Interoperability endpoints
- jae.kimmd@direct.mybaycare.org
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1679443200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1695254400000",
"number": "1619670387",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2995 DREW ST",
"city": "CLEARWATER",
"state": "FL",
"postal_code": "337593012",
"telephone_number": "727-315-7496"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "21808 STATE ROAD 54",
"city": "LUTZ",
"state": "FL",
"postal_code": "335496923",
"telephone_number": "813-922-8621"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KIM",
"first_name": "JAE",
"middle_name": "HYUN",
"credential": "MD",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2023-03-22",
"last_updated": "2023-09-21",
"certification_date": "2023-09-21",
"status": "A"
},
"taxonomies": [
{
"code": "390200000X",
"taxonomy_group": "",
"desc": "Student in an Organized Health Care Education/Training Program",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [
{
"endpointType": "DIRECT",
"endpointTypeDescription": "Direct Messaging Address",
"endpoint": "jae.kimmd@direct.mybaycare.org",
"affiliation": "Y",
"affiliationName": "BayCare Behavioral Health Associates LLC",
"use": "HIE",
"useDescription": "Health Information Exchange (HIE)",
"contentType": "CSV",
"contentTypeDescription": "CSV",
"address_1": "21808 State Road 54",
"city": "Lutz",
"state": "FL",
"country_code": "US",
"postal_code": "335496923",
"country_name": "United States",
"address_type": "DOM"
}
],
"other_names": []
}Other providers in Lutz, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 21, 2023; 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.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.