Samuel Kim

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

95028798 Issued in CA

Practice address

20601 West Paoli LN
Weimar, CA 95736

Phone

(530) 637-4025

NPI assigned

Feb 20, 2024

Last updated

Feb 20, 2024By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

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: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Nurse Practitioner

Education

Emory University School of Medicine, 2023

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Newstart Medical Group IncGroup PAC ID 8628299799, 22 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Sutter Auburn Faith Hospital Hospital, Auburn, CA, CCN 050498

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

State licenses

Practice roles

Interoperability endpoints

• Direct secure messaging: samuel.kim.1@11511.direct.athenahealth.com

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.

• Newstart Medical Group Inc

  dba Blue Stone Health and Wellness

  • Rural Health Clinic/Center
  • Weimar, CA
  • NPI 1588072698
  Medicare reassignment Care Compare group NPD
• St. Johns Community Health

  • Federally Qualified Health Center (FQHC)
  • Los Angeles, CA
  • NPI 1073653630
  Medicare reassignment

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

• Sutter Valley Hospitals

  dba Sutter Auburn Faith Hospital

  • General Acute Care Hospital
  • Auburn, CA
  • NPI 1194774299
  Care Compare affiliation
• Sutter Valley Hospitals

  • Home Health Agency
  • Auburn, CA
  • NPI 1417987751

  Hospital

  Care Compare affiliation

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

{
    "created_epoch": "1708387200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1708387200000",
    "number": "1750146536",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "20601 WEST PAOLI LN",
            "city": "WEIMAR",
            "state": "CA",
            "postal_code": "95736",
            "telephone_number": "530-637-4025"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "20601 WEST PAOLI LN",
            "city": "WEIMAR",
            "state": "CA",
            "postal_code": "95736",
            "telephone_number": "530-637-4025"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KIM",
        "first_name": "SAMUEL",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2024-02-20",
        "last_updated": "2024-02-20",
        "certification_date": "2024-02-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "CA",
            "license": "95028798",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Spencer Jonathan Freed
• Sarah Hasel
• Elmamarie Heldzinger, LPC-MHSP, APCC
• Krystina Holliday, RN, BSN
• Clarence Sinn Fook Ing, MD
• Theresa G Leal, LCSW
• Michelle Lee Little, RDH23156
• Grace Reiko Lossev
• Nedley Clinic P C
• Lisa Neish, RDH, BS

• Family Nurse Practitioner in Weimar, CA
• Providers in Weimar, CA by specialty
• Family Nurse Practitioner in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 20, 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.