Sam Y Kim, M.D.

Primary specialty

Otolaryngology PhysicianTaxonomy code 207Y00000X

License

5779 Issued in AK

Practice address

1919 Lathrop St
Ste 103
Fairbanks, AK 99701-5937

Phone

(907) 456-7768

Fax

(907) 456-4045

NPI assigned

Dec 19, 2006

Sex

Male

Sole proprietor

No

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

Specialties & licenses 3

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in AK, TX2 enrollments

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 2

Specialty

OtolaryngologyAlso: Allergy/Immunology

Education

New York Medical College, 1998

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Ear Nose and Throat Clinic IncGroup PAC ID 2860384484, 5 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Fairbanks Memorial Hospital Hospital, Fairbanks, AK, CCN 020012

Merit-based Incentive Payment System (MIPS)

Final score

0 of 100Reported as individual

Quality

0

Improvement activities

0

Cost

0

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: sam.kim.1@15989.direct.athenahealth.com

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.

• Ear Nose & Throat Clinic Inc.

  • Otolaryngology Physician
  • Fairbanks, AK
  • NPI 1023179587
  Medicare reassignment Care Compare group Authorized official
• Tanana Chiefs Conference

  • Multi-Specialty Clinic/Center
  • Fairbanks, AK
  • NPI 1821201278

  TX

  Medicare reassignment NPD
• Tanana Chiefs Conference

  • Ambulatory Surgical Clinic/Center
  • Fairbanks, AK
  • NPI 1871332387
  NPD

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

• Fairbanks Memorial Hospital, LLC

  • General Acute Care Hospital
  • Fairbanks, AK
  • NPI 1720537178
  Care Compare affiliation

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

{
    "created_epoch": "1166486400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1459468800000",
    "number": "1851454615",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1919 LATHROP ST",
            "address_2": "STE 103",
            "city": "FAIRBANKS",
            "state": "AK",
            "postal_code": "997015937",
            "telephone_number": "907-456-7768",
            "fax_number": "907-456-4045"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1919 LATHROP ST",
            "address_2": "STE 103",
            "city": "FAIRBANKS",
            "state": "AK",
            "postal_code": "997015937",
            "telephone_number": "907-456-7768",
            "fax_number": "907-456-4045"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KIM",
        "first_name": "SAM",
        "middle_name": "Y",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-12-19",
        "last_updated": "2016-04-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Y00000X",
            "taxonomy_group": "",
            "desc": "Otolaryngology",
            "state": "AK",
            "license": "5779",
            "primary": true
        },
        {
            "code": "207Y00000X",
            "taxonomy_group": "",
            "desc": "Otolaryngology",
            "state": "IN",
            "license": "01051686A",
            "primary": false
        },
        {
            "code": "207Y00000X",
            "taxonomy_group": "",
            "desc": "Otolaryngology",
            "state": "CA",
            "license": "A99387",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "MD0304",
            "state": "AK"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Jeffrey W Kilgore, D.M.D.
• William Paul Kilgore, PA-C
• Mary Killian, RN
• Brian Killion
• Jason Kim
• Jim R Kimbal, ATC, LAT, LMT, CSCS
• Kimberly J Wonderlich MD Faad Dermatology LLC
• Heidie Kimmel
• Claire Joann Kindschi, OTD
• Kathryn L Kindt, ADVANCED NURSE PRACT

• Otolaryngology Physician in Fairbanks, AK
• Providers in Fairbanks, AK by specialty
• Otolaryngology Physician in Alaska

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 1, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.