Samuel C. Kim, MD

Primary specialty

Retina Specialist (Ophthalmology) PhysicianTaxonomy code 207WX0107X

License

A123812 Issued in CA

Practice address

555 N 13TH Ave
Upland, CA 91786-4904

Phone

(909) 982-8846

Fax

(909) 949-3967

NPI assigned

Apr 20, 2011

Last updated

Jun 24, 2020By the provider in NPPES

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 4

Addresses

Medicare fee-for-service enrollment

Enrolled in CA

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

Ophthalmology

Education

Loma Linda University School of Medicine, 2011

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Pacific Eye Institute a Medical Group IncGroup PAC ID 7911966122, 43 clinicians

Practice addresses (Care Compare)

Merit-based Incentive Payment System (MIPS)

Final score

80.15 of 100Reported as group

Quality

76.08

Promoting interoperability

72

Improvement activities

40

Cost

75.13

Procedures performed for Medicare patients

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

Networks

• BSC 65 PLUS INDIVIDUAL MAPD

Interoperability endpoints

• Direct secure messaging: skim24202@direct.llu.edu

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Pacific Eye Institute, a Medical Group, Inc.

  • Ophthalmology Physician
  • Upland, CA
  • NPI 1962422709

  Multi-Specialty

  Medicare reassignment Care Compare group NPD
• Faculty Physicians and Surgeons of Llusm

  • Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician
  • Apple Valley, CA
  • NPI 1205009917

  Multi-Specialty

  Medicare reassignment NPD
• Faculty Physicians and Surgeons of Llusm

  • Ophthalmology Physician
  • Riverside, CA
  • NPI 1033361886

  Multi-Specialty

  NPD
• Faculty Physicians and Surgeons of Llusm

  • Ophthalmology Physician
  • Loma Linda, CA
  • NPI 1437109469

  Multi-Specialty

  NPD
• Faculty Physicians and Surgeons of Llusm

  • Family Medicine Physician
  • Moreno Valley, CA
  • NPI 1558788331

  Multi-Specialty

  NPD
• Dignity Health

  dba St. Mary Medical Center

  • General Acute Care Hospital
  • Long Beach, CA
  • NPI 1194840421
  NPD (past)
• Loma Linda University Children's Hospital

  • Children's Hospital
  • Loma Linda, CA
  • NPI 1366866345
  NPD (past)
• Loma Linda University Medical Center

  • General Acute Care Hospital
  • Loma Linda, CA
  • NPI 1194731935
  NPD (past)
• Redlands Community Hospital

  • General Acute Care Hospital
  • Redlands, CA
  • NPI 1043354111
  NPD (past)
• Riverside Healthcare System, L.P.

  dba Riverside Community Hospital

  • Rehabilitation Hospital Unit
  • Riverside, CA
  • NPI 1053358010
  NPD (past)

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

{
    "created_epoch": "1303257600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1592956800000",
    "number": "1720379100",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "555 N 13TH AVE",
            "city": "UPLAND",
            "state": "CA",
            "postal_code": "917864904",
            "telephone_number": "909-982-8846",
            "fax_number": "909-949-3967"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "555 N 13TH AVE",
            "city": "UPLAND",
            "state": "CA",
            "postal_code": "917864904",
            "telephone_number": "909-982-8846",
            "fax_number": "909-949-3967"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "7501 Greenway Center Dr # 300",
            "address_purpose": "LOCATION",
            "city": "Greenbelt",
            "state": "MD",
            "postal_code": "207703514",
            "country_code": "US",
            "telephone_number": "301-474-4679",
            "fax_number": "301-474-7182",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "11370 Anderson St Ste 1800",
            "address_purpose": "LOCATION",
            "city": "Loma Linda",
            "state": "CA",
            "postal_code": "923543450",
            "country_code": "US",
            "telephone_number": "909-558-2154",
            "fax_number": "909-558-2180",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "KIM",
        "first_name": "SAMUEL",
        "middle_name": "C.",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2011-04-20",
        "last_updated": "2020-06-24",
        "certification_date": "2020-06-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": "OH",
            "license": null,
            "primary": false
        },
        {
            "code": "207W00000X",
            "taxonomy_group": "",
            "desc": "Ophthalmology",
            "state": "DC",
            "license": "MD042959",
            "primary": false
        },
        {
            "code": "207W00000X",
            "taxonomy_group": "",
            "desc": "Ophthalmology",
            "state": "VA",
            "license": "0101257811",
            "primary": false
        },
        {
            "code": "207WX0107X",
            "taxonomy_group": "",
            "desc": "Ophthalmology, Retina Specialist",
            "state": "CA",
            "license": "A123812",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• John J Kim, M.D.
• Jong Wan Kim
• Junghwa Kim
• Moon Jeong Kim
• Myungsoon Kim, L.AC.
• Un Bong (Anne) Lee Kim, M.D.
• King Speech Therapy Services PC
• Edna Lee King, NURSE PRACTITIONER
• Julie Anne King, M.D.
• Kinsmen LLC

• Retina Specialist (Ophthalmology) Physician in Upland, CA
• Providers in Upland, CA by specialty
• Retina Specialist (Ophthalmology) Physician in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 24, 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.
• 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.