NPIMap

Individual provider Active NPI

Jisoo Kim

  • Diagnostic Radiology Physician
  • Boston, MA
National Provider Identifier
1770939399
Registry record updated Jun 23, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Diagnostic Radiology PhysicianTaxonomy code 2085R0202X
License
281745 Issued in MA
Practice address
75 Francis St
Boston, MA 02115-6110
Phone
(617) 732-5500
NPI assigned
May 12, 2016
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 23, 2022

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Diagnostic Radiology Physician 2085R0202X 125.069009 IL
Student in an Organized Health Care Education/Training Program 390200000X
Diagnostic Radiology Physician 2085R0202X 281745 MA Primary

Addresses

Primary practice location

75 Francis St
Boston, MA 02115-6110

Mailing address

75 Francis St
Boston, MA 02115-6110
Phone (617) 732-5500

Other practice location 1

7435 W Talcott Ave
Presence Resurrection Medical Center
Chicago, IL 60631-3707
Phone (773) 990-5978

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MA, NH2 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
I20220711000115 MA Practitioner - Diagnostic Radiology 9133410798 Reassigns benefits to 7 organizations
I20230705003026 NH Practitioner - Diagnostic Radiology 9133410798 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Diagnostic Radiology
Education
Geisel School of Medicine at Dartmouth, 2016
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

55 Fruit St
Boston, MA 02114-2696
Phone (617) 724-0287

75 Francis St
Boston, MA 02115-6110
Phone (617) 732-5500

789 Central Ave
Dover, NH 03820-2526
Phone (617) 643-0003

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
125.069009ILMDDiagnostic Radiology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Brigham & Womens Physicians Organization Inc CurrentSince Aug 1, 2022 Accepting new patients
Cooley Dickinson Hospital Inc CurrentSince Aug 1, 2022 Accepting new patients
The McLean Hospital Corporation CurrentSince Aug 1, 2022 Accepting new patients
Mass General Brigham Medical Group Western Massachusetts Inc CurrentSince Aug 1, 2022 Accepting new patients
Harbor Medical Associates, Inc. Diagnostic Radiology CurrentSince Aug 1, 2022 Accepting new patients
Cooley Dickinson Hospital Inc Current Accepting new patients
Cooley Dickinson Hospital Inc CurrentSince Aug 1, 2022 Accepting new patients
The General Hospital Corporation CurrentSince May 23, 2023 Accepting new patients
Harbor Medical Associates, Inc. CurrentSince Aug 1, 2022 Accepting new patients
Brigham and Women'S Hospital Current Accepting new patients
Hampshire Pathologists, Inc. Current Accepting new patients
Mass General Brigham Medical Group Western Massachusetts Inc Past Accepting new patients

Locations

115 Mill St
Belmont, MA 02478
Phone (617) 855-2000

75 Francis St
Boston, MA 02115

55 Fruit St
#2
Boston, MA 02114
Phone (617) 726-2967

55 Fruit St
Boston, MA 02114

1153 Centre St
Jamaica Plain, MA 02130
Phone (617) 983-7000

254 2nd Ave
Lowr
Needham Heights, MA 02494
Phone (781) 416-8400

30 Locust St
Northampton, MA 01060
Phone (413) 582-2000

541 Main St
Ste 201
South Weymouth, MA 02190
Phone (781) 335-4815

541 Main St
Ste 314
Weymouth, MA 02190
Phone (781) 952-1200

789 Central Ave
Dover, NH 03820
Phone (603) 740-2832

Interoperability endpoints

  • Direct secure messaging: kim.jisoo.bwh@direct.partners.masshiway.net

Organizations & group practices 13

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.

View all 13

Hospital & facility affiliations 7

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": "1463011200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1655942400000",
    "number": "1770939399",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "75 FRANCIS ST",
            "city": "BOSTON",
            "state": "MA",
            "postal_code": "021156110",
            "telephone_number": "617-732-5500"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "75 FRANCIS ST",
            "city": "BOSTON",
            "state": "MA",
            "postal_code": "021156110",
            "telephone_number": "617-732-5500"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "7435 W Talcott Ave",
            "address_2": "Presence Resurrection Medical Center",
            "address_purpose": "LOCATION",
            "city": "Chicago",
            "state": "IL",
            "postal_code": "606313707",
            "country_code": "US",
            "telephone_number": "773-990-5978",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "KIM",
        "first_name": "JISOO",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2016-05-12",
        "last_updated": "2022-06-23",
        "certification_date": "2022-06-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2085R0202X",
            "taxonomy_group": "",
            "desc": "Radiology, Diagnostic Radiology",
            "state": "IL",
            "license": "125.069009",
            "primary": false
        },
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "2085R0202X",
            "taxonomy_group": "",
            "desc": "Radiology, Diagnostic Radiology",
            "state": "MA",
            "license": "281745",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Boston, MA

Sources for this page

Verify at the official NPI Registry.