Individual provider Active NPI

Hyo Jin Kim, NP

  • Adult Health Nurse Practitioner
  • Roswell, GA
National Provider Identifier
1720116163
Registry record updated Oct 6, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Adult Health Nurse PractitionerTaxonomy code 363LA2200X
License
RN118947NP Issued in GA
Practice address
1357 Hembree Road
Suite 150
Roswell, GA 30076-5723
Phone
(770) 664-6075
Fax
(770) 664-5131
NPI assigned
Feb 28, 2007
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 6, 2011

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Nurse Practitioner 363L00000X 118947 GA
Adult Health Nurse Practitioner 363LA2200X RN118947NP GA Primary

Addresses

Primary practice location

1357 Hembree Road
Suite 150
Roswell, GA 30076-5723

Mailing address

1357 Hembree Road
Suite 150
Roswell, GA 30076-5723
Phone (770) 664-6075

Other identifiers 1

IdentifierTypeStateIssuer
003112614AMedicaidGA

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in GA
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

Enrollment IDStateProvider typePAC IDDetails
I20041008001164 GA Practitioner - Nurse Practitioner 4789643263 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2004
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Piedmont Cardiology of Atlanta, LLCGroup PAC ID 0345321691, 478 clinicians

Practice addresses (Care Compare)

1266 Hwy 515 S
Jasper, GA 30143-4872
Phone (706) 692-2441

1412 Milstead Ave NE
Conyers, GA 30012-3877
Phone (770) 918-3000

400 Tower Rd NE
Suite 110
Marietta, GA 30060-9417
Phone (770) 720-2383

Hospital & facility affiliations

  • Piedmont Hospital, Inc Hospital, Atlanta, GA, CCN 110083
  • Piedmont Mountainside Hospital Inc Hospital, Jasper, GA, CCN 110225

Merit-based Incentive Payment System (MIPS)

Final score
91.62 of 100Reported as apm
Quality
83.25
Promoting interoperability
100
Improvement activities
40

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
RN118947NPGAMDAdult Health Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Piedmont Cardiology of Atlanta, LLC CurrentSince Dec 26, 2010 Accepting new patients
Cardiology of Georgia Past Accepting new patients

Locations

275 Collier Rd NW
Ste 300
Atlanta, GA 30309
Phone (404) 350-0009

3950 Austell Rd
Austell, GA 30106
Phone (770) 732-3752

1412 Milstead Ave NE
Conyers, GA 30012
Phone (770) 918-3000

1357 Hembree Rd
Ste 150
Roswell, GA 30076
Phone (770) 582-1911

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.

Hospital & facility affiliations 2

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": "1172620800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1317859200000",
    "number": "1720116163",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1357 HEMBREE ROAD",
            "address_2": "SUITE 150",
            "city": "ROSWELL",
            "state": "GA",
            "postal_code": "300765723",
            "telephone_number": "770-664-6075",
            "fax_number": "770-664-5131"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1357 HEMBREE ROAD",
            "address_2": "SUITE 150",
            "city": "ROSWELL",
            "state": "GA",
            "postal_code": "300765723",
            "telephone_number": "770-664-6075",
            "fax_number": "770-664-5131"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KIM",
        "first_name": "HYO",
        "middle_name": "JIN",
        "name_prefix": "Ms.",
        "credential": "NP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-02-28",
        "last_updated": "2011-10-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "GA",
            "license": "118947",
            "primary": false
        },
        {
            "code": "363LA2200X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Adult Health",
            "state": "GA",
            "license": "RN118947NP",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "003112614A",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Roswell, GA

Sources for this page

Verify at the official NPI Registry.