Individual provider Active NPI

Minji Kim, M.D.

  • Neurology Physician
  • Medford, OR
National Provider Identifier
1720424591
Registry record updated Mar 18, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Neurology PhysicianTaxonomy code 2084N0400X
License
MD196401 Issued in OR
Practice address
920 Royal Ave
Medford, OR 97504-6169
Phone
(541) 732-8400
Fax
(541) 732-3407
NPI assigned
May 20, 2013
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 18, 2021

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Neurology Physician 2084N0400X MD196401 OR Primary
Neurology Physician 2084N0400X MD60861213 WA

Addresses

Primary practice location

920 Royal Ave
Medford, OR 97504-6169

Mailing address

PO Box 3158
Portland, OR 97208-3158
Phone (541) 732-8400

Other identifiers 1

IdentifierTypeStateIssuer
R213587OtherORMEDICARE

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address mkim935533@oc.providencedirect.org

Medicare participation

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

Enrollment IDStateProvider typePAC IDDetails
I20230514000013 NC Practitioner - Neuropsychiatry 8123244241 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Neuropsychiatry
Education
Other, 2011
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Proactive Therapy of North Carolina IncGroup PAC ID 6305753120, shared by 5 NPIs, 540 clinicians
Carolina Physical Therapy Associates LLCGroup PAC ID 7012989684, shared by 7 NPIs, 496 clinicians
Select Physical Therapy Holdings IncGroup PAC ID 9537076401, shared by 76 NPIs, 1,992 clinicians
Vidant Medical Group LLCGroup PAC ID 0345343893, 986 clinicians

Practice addresses (Care Compare)

2303 Wellington Dr SW
Wilson, NC 27893-8620
Phone (252) 243-6818

2470 Emerald PL
Greenville, NC 27834-5786
Phone (252) 355-6300

2654 M L King Jr Blvd
New Bern, NC 28562-4238
Phone (252) 637-0093

9 Medical Dr
Greenville, NC 27834-2805
Phone (252) 816-9700

Hospital & facility affiliations

  • Ecu Health Medical Center Hospital, Greenville, NC, CCN 340040
  • Vidant Chowan Hospital Hospital, Edenton, NC, CCN 341318
  • Vidant Roanoke Chowan Hospital Hospital, Ahoskie, NC, CCN 340099
  • Ecu Health North Hospital Hospital, Roanoke Rapids, NC, CCN 340151
  • The Outer Banks Hospital, Inc Hospital, Nags Head, NC, CCN 341324

Merit-based Incentive Payment System (MIPS)

Final score
96.95 of 100Reported as apm
Quality
82.44
Promoting interoperability
100
Improvement activities
40

Procedures performed for Medicare patients

ProcedureNumber of procedures
Skin biopsy1-10

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Vidant Medical Group LLC CurrentSince May 1, 2023 Accepting new patients
Vidant Medical Group LLC CurrentSince May 1, 2023 Accepting new patients

Locations

2280 Hemby Ln
Greenville, NC 27834
Phone (252) 744-9400

401 N Main St
Kenansville, NC 28349
Phone (910) 296-0941

Interoperability endpoints

  • Direct secure messaging: mkim935533@oc.providencedirect.org

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 6

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": "1369008000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1616025600000",
    "number": "1720424591",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 3158",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972083158",
            "telephone_number": "541-732-8400"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "920 ROYAL AVE",
            "city": "MEDFORD",
            "state": "OR",
            "postal_code": "975046169",
            "telephone_number": "541-732-8400",
            "fax_number": "541-732-3407"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KIM",
        "first_name": "MINJI",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2013-05-20",
        "last_updated": "2021-03-18",
        "certification_date": "2021-03-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2084N0400X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Neurology",
            "state": "OR",
            "license": "MD196401",
            "primary": true
        },
        {
            "code": "2084N0400X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Neurology",
            "state": "WA",
            "license": "MD60861213",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE",
            "identifier": "R213587",
            "state": "OR"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "mkim935533@oc.providencedirect.org",
            "affiliation": "N",
            "address_1": "920 Royal Ave",
            "city": "Medford",
            "state": "OR",
            "country_code": "US",
            "postal_code": "975046169",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Medford, OR

Sources for this page

Verify at the official NPI Registry.