NPIMap

Organization Active NPI

J Kim Radiology Associates PA

  • Specialist
  • Petersburg, WV
National Provider Identifier
1841293883
Registry record updated Nov 25, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
SpecialistTaxonomy code 174400000X
Legal business name
J KIM RADIOLOGY ASSOCIATES PA
Practice address
1 Hospital Dr
Petersburg, WV 26847-9549
Phone
(304) 257-1026
Fax
(304) 257-9776
NPI assigned
May 23, 2005
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 25, 2024

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

Authorized official

Name
Dr. Jong K Kim, M.D.NPI 1255334900
Title
President
Phone
(301) 724-1646

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
SpecialistGroup: 193400000X SINGLE SPECIALTY GROUP 174400000X Primary

Addresses

Primary practice location

1 Hospital Dr
Petersburg, WV 26847-9549

Mailing address

PO Box 808
Cumberland, MD 21501-0808
Phone (301) 724-1646

Other identifiers 6

IdentifierTypeStateIssuer
DA4688OtherRAILROAD MEDICARE
J247OtherMDMD BLUE SHIELD
0208455000MedicaidWV
001706092OtherWVMT ST BLUE SHIELD
215AOtherMDMD BLUE SHIELD
403914904MedicaidMD

Other names 1

  • PRO RADIOLOGY Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WV, MD, VA3 enrollments

Enrollment records 3

Enrollment IDStateProvider typePAC IDDetails
O20031204000586 WV Part B Supplier - Clinic/Group Practice 9335044197 Receives reassigned benefits from 1 practitioner
Practice locations: Petersburg, WV
O20040511000675 MD Part B Supplier - Clinic/Group Practice 9335044197 Receives reassigned benefits from 1 practitioner
Practice locations: Cumberland, MD
O20120612000532 VA Part B Supplier - Clinic/Group Practice 9335044197 Receives reassigned benefits from 1 practitioner
Practice locations: Leesburg, VA

National Provider Directory

National Provider Directory

Locations

14302 Barton Blvd SW
Cumberland, MD 21502
Phone (301) 729-3278

109 War Memorial Dr
Berkeley Springs, WV 25411
Phone (304) 258-1234

549 Center Ave
#H
Romney, WV 26757
Phone (304) 822-4561

Practitioners & affiliated clinicians

Practitioners 12

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1116806400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1732492800000",
    "number": "1841293883",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 808",
            "city": "CUMBERLAND",
            "state": "MD",
            "postal_code": "215010808",
            "telephone_number": "301-724-1646",
            "fax_number": "301-724-7429"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1 HOSPITAL DR",
            "city": "PETERSBURG",
            "state": "WV",
            "postal_code": "268479549",
            "telephone_number": "304-257-1026",
            "fax_number": "304-257-9776"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "J KIM RADIOLOGY ASSOCIATES PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-05-23",
        "last_updated": "2024-11-25",
        "certification_date": "2024-11-25",
        "status": "A",
        "authorized_official_last_name": "KIM",
        "authorized_official_first_name": "JONG",
        "authorized_official_middle_name": "K",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "301-724-1646",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Specialist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "DA4688",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MD BLUE SHIELD",
            "identifier": "J247",
            "state": "MD"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0208455000",
            "state": "WV"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MT ST BLUE SHIELD",
            "identifier": "001706092",
            "state": "WV"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MD BLUE SHIELD",
            "identifier": "215A",
            "state": "MD"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "403914904",
            "state": "MD"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "PRO RADIOLOGY",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Petersburg, WV

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 25, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.