Individual provider Active NPI

Il Kyoon Kim

  • Vascular & Interventional Radiology Physician
  • Baltimore, MD
National Provider Identifier
1740717248
Registry record updated Jun 30, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Vascular & Interventional Radiology PhysicianTaxonomy code 2085R0204X
License
D87443 Issued in MD
Practice address
345 St Paul PL
Baltimore, MD 21202
Phone
(410) 332-9000
NPI assigned
May 15, 2017
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 30, 2023

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Student in an Organized Health Care Education/Training Program 390200000X
Vascular & Interventional Radiology Physician 2085R0204X D87443 MD Primary

Addresses

Primary practice location

345 St Paul PL
Baltimore, MD 21202

Mailing address

345 St Paul PL
Baltimore, MD 21202

Other practice location 1

827 Linden Ave
Baltimore, MD 21201-4606
Phone (410) 225-8790

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MD
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
I20230809001808 MD Practitioner - Diagnostic Radiology 8022470921 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Diagnostic Radiology
Education
George Washington University School of Medicine, 2017
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
St Paul Place Specialists, Inc.Group PAC ID 7719882943, 332 clinicians

Practice addresses (Care Compare)

301 Saint Paul St
Baltimore, MD 21202-2102
Phone (410) 659-2800

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
79.13 of 100Reported as group
Quality
56.5
Promoting interoperability
100
Improvement activities
40
Cost
73.94

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
D87443MDMDVascular & Interventional Radiology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
St Paul Place Specialists Inc CurrentSince Jul 13, 2023 Accepting new patients
St. Paul Place Specialists, Inc. Current Accepting new patients

Locations

301 Saint Paul St
Baltimore, MD 21202
Phone (410) 385-4930

Interoperability endpoints

  • Direct secure messaging: ikim95520@direct.mdmercy.com

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": "1494806400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1688083200000",
    "number": "1740717248",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "345 ST PAUL PL",
            "city": "BALTIMORE",
            "state": "MD",
            "postal_code": "21202"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "345 ST PAUL PL",
            "city": "BALTIMORE",
            "state": "MD",
            "postal_code": "21202",
            "telephone_number": "410-332-9000"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "827 Linden Ave",
            "address_purpose": "LOCATION",
            "city": "Baltimore",
            "state": "MD",
            "postal_code": "212014606",
            "country_code": "US",
            "telephone_number": "410-225-8790",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "KIM",
        "first_name": "IL KYOON",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2017-05-15",
        "last_updated": "2023-06-30",
        "certification_date": "2023-06-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "2085R0204X",
            "taxonomy_group": "",
            "desc": "Radiology, Vascular & Interventional Radiology",
            "state": "MD",
            "license": "D87443",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Baltimore, MD

Sources for this page

Verify at the official NPI Registry.