NPIMap

Individual provider Active NPI

Edward T Kim, MD

  • Nephrology Physician
  • Concord, CA
National Provider Identifier
1679619092
Registry record updated Sep 10, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nephrology PhysicianTaxonomy code 207RN0300X
License
A100042 Issued in CA
Practice address
2222 East St Ste 305
Concord, CA 94520-2066
Phone
(925) 686-1230
Fax
(925) 686-8443
NPI assigned
Jan 30, 2007
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 10, 2020

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Nephrology Physician 207RN0300X A100042 CA Primary

Addresses

Primary practice location

2222 East St Ste 305
Concord, CA 94520-2066

Mailing address

2222 East St Ste 305
Concord, CA 94520-2066
Phone (925) 686-1230

Other identifiers 1

IdentifierTypeStateIssuer
GR0020610MedicaidCA

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20070831000585 CA Practitioner - NephrologyPractitioner - Internal Medicine 6204929524 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
NephrologyAlso: Internal Medicine
Education
Other, 2001
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
West Coast KidneyGroup PAC ID 1759700149, 56 clinicians

Practice addresses (Care Compare)

110 Tampico
Suite 220
Walnut Creek, CA 94598-2962
Phone (925) 944-0351

Hospital & facility affiliations

  • FKC San Miguel Dialysis facility, Concord, CA, CCN 552864
  • Fresenius Medical Care Diablo East Antioch Dialysis facility, Antioch, CA, CCN 552680
  • Fresenius Medical Care - Diablo Walnut Creek Dialysis facility, Walnut Creek, CA, CCN 052758
  • John Muir Medical Center - Concord Campus Hospital, Concord, CA, CCN 050496
  • John Muir Medical Center - Walnut Creek Campus Hospital, Walnut Creek, CA, CCN 050180
  • Sutter Delta Medical Center Hospital, Antioch, CA, CCN 050523

Merit-based Incentive Payment System (MIPS)

Final score
96.1 of 100Reported as group
Quality
77.33
Promoting interoperability
99
Improvement activities
40
Cost
77.19

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
A100042CAMDNephrology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
John Muir Trauma Physicians Billing Service CurrentSince Oct 22, 2009 Accepting new patients
John Muir Trauma Physicians Billing Service Current Accepting new patients
Sutter Delta Medical Center Past Accepting new patients
John Muir Health Past Accepting new patients
California Pacific Medical Group, Inc. Past Accepting new patients
John Muir Health Past Accepting new patients

Locations

1601 Ygnacio Valley Rd
Walnut Creek, CA 94598
Phone (925) 295-1545

Networks

  • BSC 65 PLUS INDIVIDUAL MAPD

Interoperability endpoints

  • Direct secure messaging: edward.kim.1@8243.direct.athenahealth.com

Organizations & group practices 7

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.

Hospital & facility affiliations 5

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1170115200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1599696000000",
    "number": "1679619092",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2222 EAST ST STE 305",
            "city": "CONCORD",
            "state": "CA",
            "postal_code": "945202066",
            "telephone_number": "925-686-1230",
            "fax_number": "925-686-8443"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2222 EAST ST STE 305",
            "city": "CONCORD",
            "state": "CA",
            "postal_code": "945202066",
            "telephone_number": "925-686-1230",
            "fax_number": "925-686-8443"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KIM",
        "first_name": "EDWARD",
        "middle_name": "T",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-01-30",
        "last_updated": "2020-09-10",
        "certification_date": "2020-09-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207RN0300X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Nephrology",
            "state": "CA",
            "license": "A100042",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "GR0020610",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Concord, CA

Sources for this page

Verify at the official NPI Registry.