Individual provider Active NPI

Dukjin Im, MD

  • Physical Medicine & Rehabilitation Physician
  • Charlotte, NC
National Provider Identifier
1639105307
Registry record updated Jul 15, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical Medicine & Rehabilitation PhysicianTaxonomy code 208100000X
License
2013-02339 Issued in NC
Practice address
1001 Blythe Blvd
Medical Center Plaza Suite 200
Charlotte, NC 28203-5866
Phone
(704) 381-8840
NPI assigned
Jun 24, 2006
Last updated
Jul 15, 2024By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 15, 2024

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatrics Physician 208000000X 2013-02339 NC
Pediatric Rehabilitation Medicine Physician 2081P0010X 2013-02339 NC
Physical Medicine & Rehabilitation Physician 208100000X 2013-02339 NC Primary

Addresses

Primary practice location

1001 Blythe Blvd
Medical Center Plaza Suite 200
Charlotte, NC 28203-5866

Mailing address

PO Box 19305
Charlotte, NC 28219-9305

Other practice location 1

1100 Blythe Blvd
Charlotte, NC 28203-5814
Phone (704) 355-9330

Other practice location 2

100 Medical Park Dr
Ste 310
Concord, NC 28025-2948
Phone (704) 403-2660

Other practice location 3

2550 Court Dr
Gastonia, NC 28054-2152
Phone (704) 381-8840

Other practice location 4

1001 Blythe Blvd
Ste 500
Charlotte, NC 28203-5866
Phone (704) 373-1813

Electronic endpoints 2

TypeEndpointUseAffiliation
Direct Messaging Address dim51873@CarolinasHealthcareSystem.direct-ci.com Atrium Health
CONNECT URL https://esmd.abilitynetwork.com:8291/Gateway/DocumentSubmission/2_0/NhinService/XDRRequest_Service Other ABILITY Network

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NC
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

Enrollment IDStateProvider typePAC IDDetails
I20140305000633 NC Practitioner - Physical Medicine and RehabilitationPractitioner - Sports MedicinePractitioner - Pediatric Medicine 9739319153 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physical Medicine and RehabilitationAlso: Pediatric Medicine, Sports Medicine
Education
University of Michigan Medical School, 1990
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Carolinas Medical CenterGroup PAC ID 4789597477, 1,057 clinicians

Practice addresses (Care Compare)

1000 Blythe Blvd
Charlotte, NC 28203-5812
Phone (704) 355-2000

Merit-based Incentive Payment System (MIPS)

Final score
94 of 100Reported as apm
Quality
81.63
Promoting interoperability
100
Improvement activities
40

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Carolinas Medical Center Pediatrics CurrentSince Jan 20, 2014 Accepting new patients
Carolinas Physicians Network Inc Current Accepting new patients
Carolinas Pathology Group, PA Current Accepting new patients
Carolinas Physicians Network Inc CurrentSince Jun 9, 2021 Accepting new patients
Carolinas Physicians Network Inc. CurrentSince Jun 9, 2021 Accepting new patients
Carolinas Medical Center CurrentSince Jan 20, 2014 Accepting new patients
The Charlotte-Mecklenburg Hospital Authority CurrentSince Aug 22, 2024 Accepting new patients
The Charlotte-Mecklenburg Hospital Authority Current Accepting new patients
The Charlotte-Mecklenburg Hospital Authority CurrentSince Aug 22, 2024 Accepting new patients
Carolinas Medical Center Pediatrics Current Accepting new patients

Locations

100 N 6th St
Ste 900A
Minneapolis, MN 55403

1000 Blythe Blvd
Charlotte, NC 28203
Phone (704) 351-3791

1001 Blythe Blvd
Ste 500
Charlotte, NC 28203
Phone (704) 355-5100

1100 Blythe Blvd
Charlotte, NC 28203
Phone (704) 355-4300

1001 Blythe Blvd
Ste 200
Charlotte, NC 28203
Phone (704) 373-0544

100 Medical Park Dr
Ste 310
Concord, NC 28025
Phone (704) 403-2860

487 Lake Concord Rd NE
Concord, NC 28025
Phone (704) 403-0100

2550 Court Dr
Gastonia, NC 28054
Phone (252) 773-0195

134 Medical Park Rd
Ste 111
Mooresville, NC 28117
Phone (704) 801-9100

Interoperability endpoints

  • Direct secure messaging: dim51873@carolinashealthcaresystem.direct-ci.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, 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": "1151107200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1721001600000",
    "number": "1639105307",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 19305",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282199305"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1001 BLYTHE BLVD",
            "address_2": "MEDICAL CENTER PLAZA SUITE 200",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282035866",
            "telephone_number": "704-381-8840"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1100 Blythe Blvd",
            "address_purpose": "LOCATION",
            "city": "Charlotte",
            "state": "NC",
            "postal_code": "282035814",
            "country_code": "US",
            "telephone_number": "704-355-9330",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "100 Medical Park Dr",
            "address_2": "Ste 310",
            "address_purpose": "LOCATION",
            "city": "Concord",
            "state": "NC",
            "postal_code": "280252948",
            "country_code": "US",
            "telephone_number": "704-403-2660",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "2550 Court Dr",
            "address_purpose": "LOCATION",
            "city": "Gastonia",
            "state": "NC",
            "postal_code": "280542152",
            "country_code": "US",
            "telephone_number": "704-381-8840",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1001 Blythe Blvd",
            "address_2": "Ste 500",
            "address_purpose": "LOCATION",
            "city": "Charlotte",
            "state": "NC",
            "postal_code": "282035866",
            "country_code": "US",
            "telephone_number": "704-373-1813",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "IM",
        "first_name": "DUKJIN",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-06-24",
        "last_updated": "2024-07-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "NC",
            "license": "2013-02339",
            "primary": false
        },
        {
            "code": "2081P0010X",
            "taxonomy_group": "",
            "desc": "Physical Medicine & Rehabilitation, Pediatric Rehabilitation Medicine",
            "state": "NC",
            "license": "2013-02339",
            "primary": false
        },
        {
            "code": "208100000X",
            "taxonomy_group": "",
            "desc": "Physical Medicine & Rehabilitation",
            "state": "NC",
            "license": "2013-02339",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "dim51873@CarolinasHealthcareSystem.direct-ci.com",
            "affiliation": "Y",
            "affiliationName": "Atrium Health",
            "address_1": "1001 Blythe Blvd",
            "address_2": "Medical Center Plaza, Suite 200",
            "city": "Charlotte",
            "state": "NC",
            "country_code": "US",
            "postal_code": "282035866",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "https://esmd.abilitynetwork.com:8291/Gateway/DocumentSubmission/2_0/NhinService/XDRRequest_Service",
            "affiliation": "Y",
            "endpointDescription": "2.16.840.1.113883.3.667.2",
            "affiliationName": "ABILITY Network",
            "use": "OTHER",
            "useDescription": "Other",
            "useOtherDescription": "CMS esMD eMDR",
            "address_1": "100 N 6th St Ste 900A",
            "city": "Minneapolis",
            "state": "MN",
            "country_code": "US",
            "postal_code": "554031516",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Charlotte, NC

Sources for this page

Verify at the official NPI Registry.