Individual provider Active NPI

Eugene M Kim

  • Colon & Rectal Surgery Physician
  • Phoenix, AZ
National Provider Identifier
1770570293
Registry record updated Jul 16, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Colon & Rectal Surgery PhysicianTaxonomy code 208C00000X
License
33968 Issued in AZ
Practice address
1441 N 12TH St FL 3
Phoenix, AZ 85006-2837
Phone
(602) 521-5100
Fax
(623) 707-4243
NPI assigned
Sep 30, 2005
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 16, 2025

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Colon & Rectal Surgery Physician 208C00000X 33968 AZ Primary

Addresses

Primary practice location

1441 N 12TH St FL 3
Phoenix, AZ 85006-2837

Mailing address

1441 N 12TH St FL 3
Phoenix, AZ 85006-2837
Phone (602) 521-5100

Other identifiers 1

IdentifierTypeStateIssuer
933128MedicaidAZ

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in AZ
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
I20050512000596 AZ Practitioner - Colorectal Surgery (Proctology)Practitioner - General Surgery 4486695194 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Colorectal Surgery (Proctology)Also: General Surgery
Education
State University of New York Downstate Medical Center, 1997
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Banner - University Physician Specialists LLCGroup PAC ID 5991008054, 343 clinicians
Banner Cancer Center Specialists LLCGroup PAC ID 6103097779, 343 clinicians

Practice addresses (Care Compare)

1441 N 12TH St
FL 2
Phoenix, AZ 85006-2837
Phone (844) 242-4664

925 E McDowell Rd
Phoenix, AZ 85006-2502
Phone (602) 521-3700

Hospital & facility affiliations

  • Banner - University Medical Center Phoenix Hospital, Phoenix, AZ, CCN 030002

Merit-based Incentive Payment System (MIPS)

Final score
82.85 of 100Reported as group
Quality
69.75
Promoting interoperability
98
Improvement activities
40
Cost
68.18

Merit-based Incentive Payment System (MIPS)

Final score
78.42 of 100Reported as group
Quality
62.19
Promoting interoperability
99
Improvement activities
40
Cost
61.29

Procedures performed for Medicare patients

ProcedureNumber of procedures
Colonoscopy61
Removal of skin lesions1-10

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
33968AZMDColon & Rectal Surgery Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Banner - University Physician Specialists LLC CurrentSince Jul 1, 2020 Accepting new patients
Banner - University Physician Specialists LLC CurrentSince Jul 1, 2020 Accepting new patients
Banner - University Medical Center Phoenix Past Accepting new patients

Locations

1400 S Dobson Rd
Mesa, AZ 85202
Phone (480) 412-3000

925 E McDowell Rd
Phoenix, AZ 85006
Phone (602) 239-4498

1441 N 12th St
Fl 3
Phoenix, AZ 85006
Phone (602) 521-5700

1300 N 12th St
Ste 508
Phoenix, AZ 85006
Phone (602) 839-3927

1441 N 12th St
Fl 2AND3
Phoenix, AZ 85006

1441 N 12th St
Fl 2
Phoenix, AZ 85006
Phone (602) 521-5180

1111 E McDowell Rd
Phoenix, AZ 85006
Phone (602) 239-2000

Organizations & group practices 4

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 1

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": "1128038400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1752624000000",
    "number": "1770570293",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1441 N 12TH ST FL 3",
            "city": "PHOENIX",
            "state": "AZ",
            "postal_code": "850062837",
            "telephone_number": "602-521-5100",
            "fax_number": "623-707-4243"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1441 N 12TH ST FL 3",
            "city": "PHOENIX",
            "state": "AZ",
            "postal_code": "850062837",
            "telephone_number": "602-521-5100",
            "fax_number": "623-707-4243"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KIM",
        "first_name": "EUGENE",
        "middle_name": "M",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-09-30",
        "last_updated": "2025-07-16",
        "certification_date": "2025-07-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208C00000X",
            "taxonomy_group": "",
            "desc": "Colon & Rectal Surgery",
            "state": "AZ",
            "license": "33968",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "933128",
            "state": "AZ"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Phoenix, AZ

Sources for this page

Verify at the official NPI Registry.