Sunggeun Samuel Im, MD

Primary specialty

Surgery PhysicianTaxonomy code 208600000X

License

C55339 Issued in CA

Practice address

11199 31/2 Mile Road
Battle Creek, MI 49015

Phone

(269) 979-2501

Fax

(269) 979-2501

NPI assigned

Jun 26, 2006

Sex

Male

Sole proprietor

No

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

Specialties & licenses 3

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in GU

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

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

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.

• General Conference Corp of Sda

  • Clinic/Center
  • Tamuning, GU
  • NPI 1275586877
  Medicare reassignment NPD

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

{
    "created_epoch": "1151280000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1359417600000",
    "number": "1770510901",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11199 3 1/2 MILE RD",
            "city": "BATTLE CREEK",
            "state": "MI",
            "postal_code": "490159370",
            "telephone_number": "269-979-2501",
            "fax_number": "269-979-2501"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11199 31/2 MILE ROAD",
            "city": "BATTLE CREEK",
            "state": "MI",
            "postal_code": "49015",
            "telephone_number": "269-979-2501",
            "fax_number": "269-979-2501"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "IM",
        "first_name": "SUNGGEUN",
        "middle_name": "SAMUEL",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-06-26",
        "last_updated": "2013-01-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208600000X",
            "taxonomy_group": "",
            "desc": "Surgery",
            "state": "GU",
            "license": "M-1695",
            "primary": false
        },
        {
            "code": "208600000X",
            "taxonomy_group": "",
            "desc": "Surgery",
            "state": "CA",
            "license": "C55339",
            "primary": true
        },
        {
            "code": "208D00000X",
            "taxonomy_group": "",
            "desc": "General Practice",
            "state": "MI",
            "license": "31469",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1077038",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Tracie Hurst
• Sajid Hussain, MD
• Robert Howard Hynes II, M.D.
• Icare Home Health Care
• Thomas F. Ignaczak, M.D.
• Tamara Inderlied
• Infinity Afc LLC
• Infinity Home Health Care, Inc.
• Raymond G Ingraham, CFNP
• Innovative Womens Health, PLC

• Surgery Physician in Battle Creek, MI
• Providers in Battle Creek, MI by specialty
• Surgery Physician in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 29, 2013; 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.