Individual provider Active NPI

Ji Hyang Kim, LCSW

  • Mental Health Counselor
  • Worcester, MA
National Provider Identifier
1659018570
Registry record updated May 13, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Mental Health CounselorTaxonomy code 101YM0800X
Practice address
12 Queen St
Worcester, MA 01610-2411
Phone
(508) 421-4411
NPI assigned
May 13, 2022
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 13, 2022

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Mental Health Counselor 101YM0800X Primary

Addresses

Primary practice location

12 Queen St
Worcester, MA 01610-2411

Mailing address

12 Queen St
Worcester, MA 01610-2411

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MA
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: No
  • Power mobility devices: No
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20221230001174 MA Practitioner - Clinical Social Worker 0143690495 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Clinical Social Worker
Education
Other, 2019
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Southcoast Physicians Group IncGroup PAC ID 0749171957, 875 clinicians

Practice addresses (Care Compare)

101 Page St
New Bedford, MA 02740-3464
Phone (508) 973-5919

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

Practice roles

OrganizationSpecialtyStatusNew patients
Community Healthlink, Inc. CurrentSince Nov 30, 2022 Accepting new patients
Southcoast Physicians Group, Inc. CurrentSince Mar 9, 2026 Accepting new patients
Southcoast Physicians Group, Inc. CurrentSince Mar 9, 2026 Accepting new patients
Community Healthlink Inc CurrentSince Nov 30, 2022 Accepting new patients

Locations

534 Prospect St
Fall River, MA 02720
Phone (508) 679-7766

363 Highland Ave
Fall River, MA 02720
Phone (508) 679-7052

40 Spruce St
#2
Leominster, MA 01453
Phone (978) 534-6116

101 Page St
New Bedford, MA 02740
Phone (508) 961-5425

26 Queen St
Worcester, MA 01610
Phone (508) 860-7700

72 Jaques Ave
Worcester, MA 01610
Phone (508) 860-1154

12 Queen St
Worcester, MA 01610
Phone (508) 860-1242

Organizations & group practices 5

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.

NPI Registry JSON

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

{
    "created_epoch": "1652400000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1652400000000",
    "number": "1659018570",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12 QUEEN ST",
            "city": "WORCESTER",
            "state": "MA",
            "postal_code": "016102411"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12 QUEEN ST",
            "city": "WORCESTER",
            "state": "MA",
            "postal_code": "016102411",
            "telephone_number": "508-421-4411"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KIM",
        "first_name": "JI HYANG",
        "credential": "LCSW",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2022-05-13",
        "last_updated": "2022-05-13",
        "certification_date": "2022-05-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Worcester, MA

Sources for this page

Verify at the official NPI Registry.