Individual provider Active NPI

Charleen Lee Kim, M.D.

  • Surgery Physician
  • Walnut Creek, CA
National Provider Identifier
1831378850
Registry record updated Jul 23, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Surgery PhysicianTaxonomy code 208600000X
License
A95969 Issued in CA
Practice address
130 La Casa Via
Building 3, Suite 211
Walnut Creek, CA 94598
Phone
(925) 933-0984
NPI assigned
Oct 25, 2007
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 23, 2021

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Surgery Physician 208600000X A95969 CA Primary

Addresses

Primary practice location

130 La Casa Via
Building 3, Suite 211
Walnut Creek, CA 94598

Mailing address

1450 Treat Blvd # 300
Walnut Creek, CA 94597-2168
Phone (925) 952-2828

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA
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
I20091023000227 CA Practitioner - General Surgery 2062559040 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
General Surgery
Education
Saint Louis University School of Medicine, 2004
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
John Muir Physician NetworkGroup PAC ID 6608789813, 488 clinicians

Practice addresses (Care Compare)

130 La Casa Via
Suite 211
Walnut Creek, CA 94598-3046
Phone (925) 933-0984

Hospital & facility affiliations

  • John Muir Medical Center - Walnut Creek Campus Hospital, Walnut Creek, CA, CCN 050180
  • John Muir Medical Center - Concord Campus Hospital, Concord, CA, CCN 050496
  • San Ramon Regional Medical Center Hospital, San Ramon, CA, CCN 050689
  • Contra Costa Regional Medical Center Hospital, Martinez, CA, CCN 050276

Merit-based Incentive Payment System (MIPS)

Final score
90.32 of 100Reported as group
Quality
89.54
Promoting interoperability
100
Improvement activities
40
Cost
74.34

Procedures performed for Medicare patients

ProcedureNumber of procedures
Hernia repair (minimally invasive)18
Mastectomy33
Melanoma (skin cancer) excision19
Removal of tissue1-10
Removal of skin lesions1-10
Skin biopsy1-10

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
A95969CAMDSurgery Physician

Practice roles

OrganizationSpecialtyStatusNew patients
John Muir Trauma Physicians Billing Service Current Accepting new patients
John Muir Physician Network CurrentSince Aug 13, 2021 Accepting new patients
John Muir Trauma Physicians Billing Service CurrentSince Aug 27, 2009 Accepting new patients
John Muir Health Past Accepting new patients
John Muir Health Past Accepting new patients
San Ramon Regional Medical Center, LLC Past Accepting new patients

Locations

2400 Balfour Rd
Ste 120
Brentwood, CA 94513
Phone (925) 308-8112

400 Taylor Blvd
Ste 202
Pleasant Hill, CA 94523
Phone (925) 932-4567

400 Taylor Blvd
Ste 105
Pleasant Hill, CA 94523
Phone (925) 687-2570

380 Civic Dr
Ste 100
Pleasant Hill, CA 94523
Phone (925) 284-3840

5201 Norris Canyon Rd
Ste 140
San Ramon, CA 94583
Phone (925) 277-7550

12677 Alcosta Blvd
Ste 220
San Ramon, CA 94583
Phone (925) 254-9840

177 La Casa Via
Ste 200AD
Walnut Creek, CA 94598

1601 Ygnacio Valley Rd
Walnut Creek, CA 94598
Phone (925) 295-1545

130 La Casa Via
Ste 211
Walnut Creek, CA 94598
Phone (925) 471-7100

1450 Treat Blvd
#300
Walnut Creek, CA 94597
Phone (925) 952-2828

1220 Rossmoor Pkwy
Walnut Creek, CA 94595
Phone (925) 947-3393

1479 Ygnacio Valley Rd
Ste 100
Walnut Creek, CA 94598
Phone (925) 627-3440

Interoperability endpoints

  • Direct secure messaging: ckim18080@ehr.johnmuirhealth.com

Organizations & group practices 6

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 4

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": "1193270400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1626998400000",
    "number": "1831378850",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1450 TREAT BLVD # 300",
            "city": "WALNUT CREEK",
            "state": "CA",
            "postal_code": "945972168",
            "telephone_number": "925-952-2828"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "130 LA CASA VIA",
            "address_2": "BUILDING 3, SUITE 211",
            "city": "WALNUT CREEK",
            "state": "CA",
            "postal_code": "94598",
            "telephone_number": "925-933-0984"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KIM",
        "first_name": "CHARLEEN",
        "middle_name": "LEE",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-10-25",
        "last_updated": "2021-07-23",
        "certification_date": "2021-07-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208600000X",
            "taxonomy_group": "",
            "desc": "Surgery",
            "state": "CA",
            "license": "A95969",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Walnut Creek, CA

Sources for this page

Verify at the official NPI Registry.