Individual provider Active NPI

Michael Kim DO, M.D.

  • Diagnostic Radiology Physician
  • Round Rock, TX
National Provider Identifier
1811144405
Registry record updated Jan 11, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Diagnostic Radiology PhysicianTaxonomy code 2085R0202X
License
N3622 Issued in TX
Practice address
300 University Blvd
Round Rock, TX 78665-1032
Phone
(512) 509-0100
NPI assigned
Aug 26, 2008
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 11, 2021

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Diagnostic Radiology Physician 2085R0202X N3622 TX Primary

Addresses

Primary practice location

300 University Blvd
Round Rock, TX 78665-1032

Mailing address

PO Box 844658
Dallas, TX 75284-4658
Phone (254) 724-8800

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address mdo10330@direct.sw.org Direct

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TX
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
I20090806000165 TX Practitioner - Diagnostic Radiology 2961555073 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Diagnostic Radiology
Education
Texas a & M University System, HSC, College of Medicine, 2004
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Scott and White ClinicGroup PAC ID 8123923604, 2,426 clinicians

Practice addresses (Care Compare)

1605 S 31St St
Baylor Scott and White Center for Dia
Temple, TX 76508-0001
Phone (254) 215-0100

1701 E Pflugerville Pkwy
Baylor Scott and White Clinic Pflug
Pflugerville, TX 78660-8990
Phone (512) 259-6000

2401 S 31 St
Temple, TX 76508-0001
Phone (254) 724-2459

2401 S 31St St BLDG
35 Baylor Scott and White Roney Bone and
Temple, TX 76508-0001
Phone (254) 724-2663

2608 Brockton Dr
Austin, TX 78758-4414
Phone (512) 654-4050

300 University Blvd
Round Rock, TX 78665-1032
Phone (512) 509-0200

302 University Blvd
Round Rock, TX 78665-1032
Phone (512) 509-0200

3108 Ranch Rd 620
Lakeway, TX 78738-5635
Phone (512) 654-4200

425 University Blvd
Round Rock, TX 78665-1053
Phone (512) 509-0200

5000 W Slaughter LN 100 BLDG
6 Baylor Scott and White Clinic Austi
Austin, TX 78749-4015
Phone (512) 291-8002

810 W U Ave
Temple, TX 76508-0001
Phone (254) 724-2585

900 E Whitestone Blvd
Cedar Park, TX 78613-9093
Phone (512) 684-4911

910 E Whitestone Blvd
Baylor Scott and White Clinic Cedar
Cedar Park, TX 78613-9093
Phone (512) 260-6100

9521 W US Hwy 290 105
Baylor Scottandwhite Clinic Austi
Austin, TX 78736-7898
Phone (512) 654-4300

Hospital & facility affiliations

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Btdi JV, LLP CurrentSince Mar 1, 2016 Accepting new patients
Scott & White Clinic Diagnostic Radiology CurrentSince Jul 6, 2009 Accepting new patients
Scott & White Clinic Diagnostic Radiology CurrentSince Jul 6, 2009 Accepting new patients
Btdi JV, LLP CurrentSince Mar 1, 2016 Accepting new patients
Scott & White Clinic Diagnostic Radiology Current Accepting new patients
Btdi JV, LLP CurrentSince Mar 1, 2016 Accepting new patients
Healthtexas Provider Network Past Accepting new patients
Scott & White Hospital - Taylor Past Accepting new patients

Locations

101 E Jackson St
Burnet, TX 78611
Phone (512) 756-7510

101 Lafferty Ave
Cameron, TX 76520
Phone (254) 605-1100

800 W Highway 71
Marble Falls, TX 78654
Phone (830) 201-7100

810 W Highway 71
Marble Falls, TX 78654
Phone (830) 201-7100

2600 E Pflugerville Pkwy
Ste 100
Pflugerville, TX 78660
Phone (512) 654-6100

1701 E Pflugerville Pkwy
Pflugerville, TX 78660
Phone (512) 259-6000

300 University Blvd
Bldg A
Round Rock, TX 78665
Phone (512) 509-0100

302 University Blvd
Round Rock, TX 78665
Phone (512) 218-6330

300 University Blvd
Round Rock, TX 78665
Phone (512) 509-0100

2401 S 31st St
Temple, TX 76508
Phone (254) 724-2459

Organizations & group practices 8

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 5

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": "1219708800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1610323200000",
    "number": "1811144405",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 844658",
            "city": "DALLAS",
            "state": "TX",
            "postal_code": "752844658",
            "telephone_number": "254-724-8800"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "300 UNIVERSITY BLVD",
            "city": "ROUND ROCK",
            "state": "TX",
            "postal_code": "786651032",
            "telephone_number": "512-509-0100"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DO",
        "first_name": "MICHAEL",
        "middle_name": "KIM",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2008-08-26",
        "last_updated": "2021-01-11",
        "certification_date": "2021-01-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2085R0202X",
            "taxonomy_group": "",
            "desc": "Radiology, Diagnostic Radiology",
            "state": "TX",
            "license": "N3622",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "mdo10330@direct.sw.org",
            "affiliation": "N",
            "use": "DIRECT",
            "useDescription": "Direct",
            "address_1": "300 University Blvd",
            "city": "Round Rock",
            "state": "TX",
            "country_code": "US",
            "postal_code": "786651032",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Round Rock, TX

Sources for this page

Verify at the official NPI Registry.