David Jaekwang Shim, M.D./PH.D.

Primary specialty

Clinical Cardiac Electrophysiology PhysicianTaxonomy code 207RC0001X

License

MD20207 Issued in RI

Practice address

593 Eddy St
Providence, RI 02903-4923

Phone

(401) 444-5891

Fax

(401) 444-8158

NPI assigned

Apr 11, 2013

Sex

Male

Sole proprietor

No

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

Specialties & licenses 3

Addresses

Medicare fee-for-service enrollment

Enrolled in RI

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

Specialty

Cardiac Electrophysiology

Education

Baylor College of Medicine, 2012

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

The Miriam HospitalGroup PAC ID 6901796408, 178 clinicians

Lifespan Physician Group IncGroup PAC ID 2567455082, 1,151 clinicians

Rhode Island HospitalGroup PAC ID 8921900044, 430 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• The Miriam Hospital Hospital, Providence, RI, CCN 410012
• Rhode Island Hospital Hospital, Providence, RI, CCN 410007

Procedures performed for Medicare patients

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine, Doctor of Philosophy

State licenses

Practice roles

Locations

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.

• Lifespan Physician Group, Inc.

  • General Practice Physician
  • Providence, RI
  • NPI 1407116643

  RI

  Medicare reassignment Care Compare group NPD
• Rhode Island Hospital

  • Advanced Heart Failure and Transplant Cardiology Physician
  • Providence, RI
  • NPI 1962844795

  Clinical Cardiac Electrophysiology, RI

  Medicare reassignment Care Compare group NPD
• The Miriam Hospital

  • Cardiovascular Disease Physician
  • Providence, RI
  • NPI 1851677470

  RI

  Medicare reassignment Care Compare group NPD
• Lifespan Physician Group, Inc.

  • Emergency Medicine Physician
  • Providence, RI
  • NPI 1568325678
  NPD
• Rhode Island Hospital

  • General Acute Care Hospital
  • Providence, RI
  • NPI 1972768174
  NPD
• The Miriam Hospital

  • Cardiac Rehabilitation Clinic/Center
  • East Greenwich, RI
  • NPI 1518482389
  NPD
• The Miriam Hospital

  • General Acute Care Hospital
  • Providence, RI
  • NPI 1770520462
  NPD
• The Miriam Hospital

  • Adult Medicine Physician
  • Providence, RI
  • NPI 1831362813
  NPD
• Lifespan Physician Group, Inc.

  • Psychiatry Physician
  • Providence, RI
  • NPI 1548506793
  NPD (past)

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

• Rhode Island Hospital

  • Ambulance
  • Providence, RI
  • NPI 1053552299

  Hospital

  Care Compare affiliation
• Rhode Island Hospital

  • Clinic/Center
  • Providence, RI
  • NPI 1154663383

  Hospital

  Care Compare affiliation
• Rhode Island Hospital

  • General Acute Care Hospital
  • Providence, RI
  • NPI 1588659528

  Hospital

  Care Compare affiliation
• Rhode Island Hospital

  • General Acute Care Hospital
  • Providence, RI
  • NPI 1972768174

  Hospital

  Care Compare affiliation
• The Miriam Hospital

  • General Acute Care Hospital
  • Providence, RI
  • NPI 1487649430

  Hospital

  Care Compare affiliation

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

{
    "created_epoch": "1365638400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1730073600000",
    "number": "1689017451",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "593 EDDY ST",
            "city": "PROVIDENCE",
            "state": "RI",
            "postal_code": "029034923",
            "telephone_number": "401-444-5891",
            "fax_number": "401-444-8158"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "593 EDDY ST",
            "city": "PROVIDENCE",
            "state": "RI",
            "postal_code": "029034923",
            "telephone_number": "401-444-5891",
            "fax_number": "401-444-8158"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SHIM",
        "first_name": "DAVID",
        "middle_name": "JAEKWANG",
        "name_prefix": "Dr.",
        "credential": "M.D./PH.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2013-04-11",
        "last_updated": "2024-10-28",
        "certification_date": "2024-10-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207RC0001X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Clinical Cardiac Electrophysiology",
            "state": "OR",
            "license": "MD208478",
            "primary": false
        },
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207RC0001X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Clinical Cardiac Electrophysiology",
            "state": "RI",
            "license": "MD20207",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Paul Harold Shield, M.D.
• Sarah-Kim Shields, M.D.
• Rita Ilene Shiff, PA-C
• Christian Shigley
• Samantha Rose Shih, MD
• Aaron Kyunghoon Shin, DDS
• Ahram Shin
• Jaewook Shin
• Jeeyong Shin, MD
• Victor H Shin, M.D.

• All providers in Providence, RI
• Clinical Cardiac Electrophysiology Physician in Rhode Island

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 28, 2024; 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.
• 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.

Verify at the official NPI Registry.