Ju Yeon Kim

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

351939 Issued in NY

Practice address

4000 Medical Center
Suite 212
Fayetteville, NY 13066

Phone

(315) 744-1570

NPI assigned

Sep 14, 2023

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other names 1

• Ms. Ju Yeon Kim Former name

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: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Nurse Practitioner

Education

Other, 2023

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Group practices

St Josephs Medical PCGroup PAC ID 4688855844, 388 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• St Joseph'S Hospital Health Center Hospital, Syracuse, NY, CCN 330140
• Oswego Hospital Hospital, Oswego, NY, CCN 330218

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

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.

• St Josephs Medical PC

  • Family Medicine Physician
  • Liverpool, NY
  • NPI 1942501747
  Medicare reassignment Care Compare group NPD
• North Medical PC

  • Family Medicine Physician
  • Liverpool, NY
  • NPI 1972563070
  NPD

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

• Oswego Hospital

  • General Acute Care Hospital
  • Oswego, NY
  • NPI 1871678458
  Care Compare affiliation
• St Josephs Hospital Health Center

  • General Acute Care Hospital
  • Syracuse, NY
  • NPI 1508815333
  Care Compare affiliation

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

{
    "created_epoch": "1694649600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1715817600000",
    "number": "1710764550",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4000 MEDICAL CENTER DR",
            "address_2": "SUITE 212",
            "city": "FAYETTEVILLE",
            "state": "NY",
            "postal_code": "13066",
            "telephone_number": "315-744-1570"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4000 MEDICAL CENTER",
            "address_2": "SUITE 212",
            "city": "FAYETTEVILLE",
            "state": "NY",
            "postal_code": "13066",
            "telephone_number": "315-744-1570"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KIM",
        "first_name": "JU",
        "middle_name": "YEON",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2023-09-14",
        "last_updated": "2024-05-16",
        "certification_date": "2024-05-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "NY",
            "license": "351939",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "JU",
            "last_name": "KIM",
            "middle_name": "YEON",
            "prefix": "MS.",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Megan E Kernan, PT, DPT
• Sarah Elizabeth Keyes, AUD
• Sheryl L Khan, RPA
• Kim Green Occupational Therapy, PC
• Bokkyu Kim, PT, PHD
• Brian R Kline, MD
• Chelsea Klock, FNP-C
• Jessica Amanda Knapp, PT
• Robert Joseph Kohlbrenner, PH.D.
• Arne Komar, LCSW

• Family Nurse Practitioner in Fayetteville, NY
• Providers in Fayetteville, NY by specialty
• Family Nurse Practitioner in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 16, 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.