NPIMap

Individual provider Active NPI

Blossom Kim

  • Physician Assistant
  • Elk Grove, CA
National Provider Identifier
1871137976
Registry record updated Mar 1, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
59082 Issued in CA
Practice address
9108 Trumbauer Way
Elk Grove, CA 95758-7434
Phone
(916) 207-4257
NPI assigned
Oct 31, 2019
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Mar 1, 2021

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X 59082 CA Primary
Student in an Organized Health Care Education/Training Program 390200000X

Addresses

Primary practice location

9108 Trumbauer Way
Elk Grove, CA 95758-7434

Mailing address

9108 Trumbauer Way
Elk Grove, CA 95758-7434
Phone (916) 207-4257

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20210629000754 CA Practitioner - Physician Assistant 1355742362 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2020
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Sutter Valley Medical FoundationGroup PAC ID 9830094515, 2,473 clinicians

Practice addresses (Care Compare)

2800 L St
Sacramento, CA 95816-5616

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

State licenses

LicenseStateTypeSpecialty
59082CAMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Sutter Valley Medical Foundation Physician Assistant CurrentSince Mar 25, 2024 Accepting new patients
Cep America - California CurrentSince Jun 4, 2021 Accepting new patients
Sutter Valley Medical Foundation CurrentSince Mar 25, 2024 Accepting new patients
Sutter Valley Hospitals Past Accepting new patients
Sutter North Medical Foundation Past Accepting new patients

Locations

8170 Laguna Blvd
Ste 303
Elk Grove, CA 95758
Phone (916) 691-5996

2720 Low Ct
Fairfield, CA 94534
Phone (707) 428-2731

1650 Creekside Dr
Folsom, CA 95630
Phone (916) 983-7400

815 Court St
Ste 7
Jackson, CA 95642
Phone (209) 257-5900

600 Coffee Rd
Modesto, CA 95355
Phone (209) 550-4755

1601 Cummins Dr
Ste D
Modesto, CA 95358
Phone (510) 851-7423

2800 L St
Ste 500
Sacramento, CA 95816
Phone (916) 454-6850

2725 Capitol Ave
Dept 400
Sacramento, CA 95816
Phone (916) 262-9386

Interoperability endpoints

  • Direct secure messaging: bkim575631@hisp.ehr.sutterhealth.org

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 3

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": "1572480000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1614556800000",
    "number": "1871137976",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9108 TRUMBAUER WAY",
            "city": "ELK GROVE",
            "state": "CA",
            "postal_code": "957587434",
            "telephone_number": "916-207-4257"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9108 TRUMBAUER WAY",
            "city": "ELK GROVE",
            "state": "CA",
            "postal_code": "957587434",
            "telephone_number": "916-207-4257"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KIM",
        "first_name": "BLOSSOM",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2019-10-31",
        "last_updated": "2021-03-01",
        "certification_date": "2021-02-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "CA",
            "license": "59082",
            "primary": true
        },
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Elk Grove, CA

Sources for this page

Verify at the official NPI Registry.