NPIMap

Individual provider Active NPI

Jeremy Inkwon Kim, M.D.

  • Vascular & Interventional Radiology Physician
  • Charlotte, NC
National Provider Identifier
1760825350
Registry record updated Oct 17, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Vascular & Interventional Radiology PhysicianTaxonomy code 2085R0204X
License
2015-00586 Issued in NC
Practice address
700 E Morehead St Ste 300
Charlotte, NC 28202
Phone
(704) 334-7800
NPI assigned
Apr 12, 2013
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 17, 2019

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

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
Diagnostic Radiology Physician 2085R0202X 82236 SC
Diagnostic Radiology Physician 2085R0202X 2015-00586 NC
Vascular & Interventional Radiology Physician 2085R0204X 82236 SC
Vascular & Interventional Radiology Physician 2085R0204X 2015-00586 NC Primary

Addresses

Primary practice location

700 E Morehead St Ste 300
Charlotte, NC 28202

Mailing address

700 E Morehead St Ste 300
Charlotte, NC 28202-2742
Phone (704) 334-7800

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in SC, NC2 enrollments
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20190725001900 SC Practitioner - Diagnostic RadiologyPractitioner - Interventional Radiology 4981825114 Reassigns benefits to 1 organization
I20190725002018 NC Practitioner - Diagnostic RadiologyPractitioner - Interventional Radiology 4981825114 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Diagnostic RadiologyAlso: Interventional Radiology
Education
University of Florida College of Medicine, 2013
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Charlotte Radiology PAGroup PAC ID 4587577390, 222 clinicians

Practice addresses (Care Compare)

1656 Riverchase Blvd
Suite 1200
Rock Hill, SC 29732-0270
Phone (803) 327-9934

920 Church St N
Concord, NC 28025-2927
Phone (704) 334-7800

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Leg revascularization (restoring blood flow)1-10

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
2015-00586NCMDDiagnostic Radiology Physician
82236SCMDDiagnostic Radiology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Carolinas Imaging Services, LLC CurrentSince Aug 1, 2019 Accepting new patients
Blue Ridge Healthcare Medical Group, Inc. CurrentSince Apr 1, 2020 Accepting new patients
Union Medical Services LLC Diagnostic Radiology CurrentSince Aug 1, 2019 Accepting new patients
Blue Ridge Healthcare Medical Group, Inc. Current Accepting new patients
Charlotte Radiology P a CurrentSince Aug 1, 2019 Accepting new patients
Blue Ridge Healthcare Medical Group Inc Diagnostic Radiology CurrentSince Apr 1, 2020 Accepting new patients
Charlotte Radiology PA Diagnostic Radiology PastSince Aug 1, 2019 Accepting new patients

Locations

700 E Morehead St
Ste 300
Charlotte, NC 28202
Phone (704) 442-4390

12335 N Community House Rd
Ste B
Charlotte, NC 28277

920 Church St N
Concord, NC 28025
Phone (704) 403-3000

2134 14th Avenue Cir NW
Ste D
Hickory, NC 28601
Phone (828) 580-1236

724 Aubrey Bell Dr
Matthews, NC 28105
Phone (704) 295-3550

2201 S Sterling St
Morganton, NC 28655
Phone (828) 580-6393

7666 Charlotte Hwy
Ste 120
Indian Land, SC 29707
Phone (803) 328-6281

1656 Riverchase Blvd
Ste 1200
Rock Hill, SC 29732
Phone (803) 327-9934

Interoperability endpoints

  • Direct secure messaging: jkim348748@carolinashealthcaresystem.direct-ci.com

Organizations & group practices 7

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 12

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": "1365724800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1571270400000",
    "number": "1760825350",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "700 E MOREHEAD ST STE 300",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282022742",
            "telephone_number": "704-334-7800"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "700 E MOREHEAD ST STE 300",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "28202",
            "telephone_number": "704-334-7800"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KIM",
        "first_name": "JEREMY",
        "middle_name": "INKWON",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2013-04-12",
        "last_updated": "2019-10-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2085R0202X",
            "taxonomy_group": "",
            "desc": "Radiology, Diagnostic Radiology",
            "state": "SC",
            "license": "82236",
            "primary": false
        },
        {
            "code": "2085R0202X",
            "taxonomy_group": "",
            "desc": "Radiology, Diagnostic Radiology",
            "state": "NC",
            "license": "2015-00586",
            "primary": false
        },
        {
            "code": "2085R0204X",
            "taxonomy_group": "",
            "desc": "Radiology, Vascular & Interventional Radiology",
            "state": "SC",
            "license": "82236",
            "primary": false
        },
        {
            "code": "2085R0204X",
            "taxonomy_group": "",
            "desc": "Radiology, Vascular & Interventional Radiology",
            "state": "NC",
            "license": "2015-00586",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Charlotte, NC

Sources for this page

Verify at the official NPI Registry.