Active NPI
Michael C. Kim, PT
- Orthopedic Physical Therapist
- Lawrenceville, GA
National Provider Identifier
1669436986
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Orthopedic Physical Therapist
- License
- PT007802
- Practice address
- 758 Old Norcross Rd
Lawrenceville, GA 30045-3385 - Phone
- (678) 985-7190
- Fax
- (678) 985-7158
- NPI assigned
- Apr 13, 2006
- Sex
- Male
- Sole proprietor
- No
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 |
|---|---|---|---|---|
| Orthopedic Physical Therapist | 2251X0800X | PT007802 | GA | Primary |
Addresses
Primary practice location
758 Old Norcross Rd
Lawrenceville, GA 30045-3385
Mailing address
758 Old Norcross Rd
Lawrenceville, GA 30045-3385
Phone (678) 985-7190
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in GA
Enrollment records 1
Care Compare profile
Medicare Care Compare- Specialty
- Physical Therapist in Private Practice
- Education
- Other, 2003
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
Practice addresses (Care Compare)
4150 Deputy Bill Cantrell Memorial Rd
Suite 350
Cumming, GA 30040-6020
Phone (678) 341-6790
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Einhorn Mandas & Bradley Rehab Inc | Orthopedic | Past | Accepting new patients |
Interoperability endpoints
- michael.kim.1@15749.direct.athenahealth.com
Organizations & group practices 2
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.
-
dba Los Alamitos Orthopedic & Sports Physical Therapy
- Physical Therapist
- Los Alamitos, CA
- NPI 1629094420
Orthopedic
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1144886400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1207612800000",
"number": "1669436986",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "758 OLD NORCROSS RD",
"city": "LAWRENCEVILLE",
"state": "GA",
"postal_code": "300453385",
"telephone_number": "678-985-7190",
"fax_number": "678-985-7158"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "758 OLD NORCROSS RD",
"city": "LAWRENCEVILLE",
"state": "GA",
"postal_code": "300453385",
"telephone_number": "678-985-7190",
"fax_number": "678-985-7158"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KIM",
"first_name": "MICHAEL",
"middle_name": "C.",
"credential": "PT",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-04-13",
"last_updated": "2008-04-08",
"status": "A"
},
"taxonomies": [
{
"code": "2251X0800X",
"taxonomy_group": "",
"desc": "Physical Therapist, Orthopedic",
"state": "GA",
"license": "PT007802",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Lawrenceville, GA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 8, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
- 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.