Samuel Kim
Individual provider Active NPI Family Nurse Practitioner · Weimar, CA
NPI 1750146536 · NPPES record last updated Feb 20, 2024
Key facts
- NPI
- 1750146536
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Family Nurse Practitioner 363LF0000X
- License
- 95028798 (CA)
- Practice address
- 20601 West Paoli LN
Weimar, CA 95736 - Phone
- (530) 637-4025
- NPI assigned
- Feb 20, 2024
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 2
Hospital & facility affiliations 2
Medicare Care Compare profile
- 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 Inc
Practice addresses (Care Compare)
20601 W Paoli LN
Weimar, CA 95736-0486
Phone (530) 637-4025
Hospital & facility affiliations
- Sutter Auburn Faith Hospital
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in CA
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: No
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20240518000605 | CA | Practitioner - Nurse Practitioner | 3375984537 | Reassigns benefits to 2 organizations |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Nurse Practitioner
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Newstart Medical Group Inc | Current |
Accepting new patients |
Interoperability endpoints
- samuel.kim.1@11511.direct.athenahealth.com
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Nurse Practitioner | 363LF0000X | 95028798 | CA | Yes |
Addresses
Primary practice location
20601 West Paoli LN
Weimar, CA 95736
Mailing address
20601 West Paoli LN
Weimar, CA 95736
Phone (530) 637-4025
Other providers in Weimar, CA
- Spencer Jonathan Freed
- Sarah Hasel
- Elmamarie Heldzinger
- Krystina Holliday
- Clarence Sinn Fook Ing
- Theresa G Leal
- Michelle Lee Little
- Grace Reiko Lossev
- Nedley Clinic P C
- Lisa Neish
All providers in Weimar, CA · Family Nurse Practitioner in California
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Feb 20, 2024. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.