Peter Kim, MD

Primary specialty

Pediatric Surgery PhysicianTaxonomy code 2086S0120X

License

MD16869 Issued in RI

Practice address

2 Dudley St Ste 190
Providence, RI 02905-3248

Phone

(401) 553-8341

Fax

(401) 868-2319

NPI assigned

Sep 13, 2011

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Electronic endpoints 1

Medicare fee-for-service enrollment

Enrolled in NY

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

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: peter.kim.usasurg@direct-address.net

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.

• Kaleida Health

  • General Acute Care Hospital
  • Buffalo, NY
  • NPI 1639209596
  Medicare reassignment NPD
• Kaleida Health

  • General Acute Care Hospital
  • Buffalo, NY
  • NPI 1245365196
  NPD
• Kaleida Health

  • Community/Retail Pharmacy
  • Buffalo, NY
  • NPI 1992540546
  NPD
• Kaleida Health

  • General Acute Care Hospital
  • Buffalo, NY
  • NPI 1427007046
  NPD (past)

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

{
    "created_epoch": "1315872000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1580860800000",
    "number": "1669754925",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 16149",
            "city": "RUMFORD",
            "state": "RI",
            "postal_code": "029160697",
            "telephone_number": "401-453-9625",
            "fax_number": "401-435-7069"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2 DUDLEY ST STE 190",
            "city": "PROVIDENCE",
            "state": "RI",
            "postal_code": "029053248",
            "telephone_number": "401-553-8341",
            "fax_number": "401-868-2319"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KIM",
        "first_name": "PETER",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2011-09-13",
        "last_updated": "2020-02-05",
        "certification_date": "2020-02-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208600000X",
            "taxonomy_group": "",
            "desc": "Surgery",
            "state": "DC",
            "license": "MD039738",
            "primary": false
        },
        {
            "code": "2086S0120X",
            "taxonomy_group": "",
            "desc": "Surgery, Pediatric Surgery",
            "state": "RI",
            "license": "MD16869",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "Peter.Kim.usasurg@direct-address.net",
            "affiliation": "N",
            "endpointDescription": "Direct",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "2 Dudley St Ste 190",
            "city": "Providence",
            "state": "RI",
            "country_code": "US",
            "postal_code": "029053248",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Jennifer Kim, MD, JD, MHA
• Jinseong Kim, MD
• Joshua Kim, M.D.
• Kang Woo Kim
• Kyung M. Kim, M.D.
• Steven Chang Kim, MD
• Su Gym Kim, M.D.
• Susan Kim, MD
• Brandi Kimble
• Brian A Kimble, MD

• Pediatric Surgery Physician in Providence, RI
• Providers in Providence, RI by specialty
• Pediatric Surgery Physician in Rhode Island

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 5, 2020; 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.

Verify at the official NPI Registry.