Active NPI
Iris Kim, M.D.
- Psychiatry Physician
- Worcester, MA
National Provider Identifier
1851754329
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Psychiatry Physician
- License
- 036152475
- Practice address
- 55 Lake Avenue North
Worcester, MA 01655 - Phone
- (508) 334-1000
- NPI assigned
- Apr 1, 2016
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Student in an Organized Health Care Education/Training Program | 390200000X | |||
| Psychiatry Physician | 2084P0800X | 036152475 | IL | Primary |
Addresses
Primary practice location
55 Lake Avenue North
Worcester, MA 01655
Mailing address
55 Lake Avenue North
Worcester, MA 01655
Phone (508) 334-1000
Other practice location 1
1500 N Halsted St Fl 2
Chicago, IL 60642-2517
Phone (217) 222-6550
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Teladoc Health Medical Group, P.a. | Psychiatry | Current | Accepting new patients |
| Woodbridge Therapy Group LLC | Past | Accepting new patients | |
| Guiding Light Health PC | Psychiatry | Past | Accepting new patients |
Interoperability endpoints
- iriskim@tdh.allscriptsdirect.net
Organizations & group practices 3
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.
-
- Family Medicine Physician
- Lewisville, TX
- NPI 1245403567
Psychiatry
-
- Psychiatry Physician
- State College, PA
- NPI 1306359914
-
- Psychologist
- Woodbridge, VA
- NPI 1427421627
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1459468800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1634083200000",
"number": "1851754329",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "55 LAKE AVENUE NORTH",
"city": "WORCESTER",
"state": "MA",
"postal_code": "01655",
"telephone_number": "508-334-1000"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "55 LAKE AVENUE NORTH",
"city": "WORCESTER",
"state": "MA",
"postal_code": "01655",
"telephone_number": "508-334-1000"
}
],
"practiceLocations": [
{
"address_1": "1500 N Halsted St Fl 2",
"address_purpose": "LOCATION",
"city": "Chicago",
"state": "IL",
"postal_code": "606422517",
"country_code": "US",
"telephone_number": "217-222-6550",
"fax_number": "217-277-2253",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "KIM",
"first_name": "IRIS",
"credential": "M.D.",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2016-04-01",
"last_updated": "2021-10-13",
"certification_date": "2021-10-13",
"status": "A"
},
"taxonomies": [
{
"code": "390200000X",
"taxonomy_group": "",
"desc": "Student in an Organized Health Care Education/Training Program",
"state": null,
"license": null,
"primary": false
},
{
"code": "2084P0800X",
"taxonomy_group": "",
"desc": "Psychiatry & Neurology, Psychiatry",
"state": "IL",
"license": "036152475",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Worcester, MA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 13, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.