NPIMap

Individual provider Active NPI

Elecia Eunju Kim, M.D. (MAY 2012)

  • Internal Medicine Physician
  • Dallas, TX
National Provider Identifier
1871851220
Registry record updated Jan 4, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
Q3533 Issued in TX
Practice address
3417 Gaston Ave
Suite 1000
Dallas, TX 75246-2016
Phone
(469) 800-9000
Fax
(469) 800-9010
NPI assigned
Apr 23, 2012
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 4, 2023

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Student in an Organized Health Care Education/Training Program 390200000X
Internal Medicine Physician 207R00000X Q3533 TX Primary

Addresses

Primary practice location

3417 Gaston Ave
Suite 1000
Dallas, TX 75246-2016

Mailing address

3417 Gaston Ave
Suite 1000
Dallas, TX 75246-2016
Phone (469) 800-9000

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address ekim225958@direct.sw.org

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TX
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
I20151014002467 TX Practitioner - Internal Medicine 0547402489 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Internal Medicine
Education
University of Oklahoma College of Medicine, 2012
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Healthtexas Provider NetworkGroup PAC ID 1355254210, 2,535 clinicians

Practice addresses (Care Compare)

4001 Worth St
Dallas, TX 75246-1608

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
Q3533TXMDInternal Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Healthtexas Provider Network--Dallas Diagnostic Association Internal Medicine CurrentSince Sep 7, 2015 Accepting new patients
Healthtexas Provider Network Internal Medicine CurrentSince Oct 15, 2018 Accepting new patients
Healthtexas Provider Network CurrentSince Oct 15, 2018 Accepting new patients
Healthtexas-Dallas Diagnostic Association Internal Medicine CurrentSince Sep 7, 2015 Accepting new patients
Healthtexas Provider Network Past Accepting new patients

Locations

3417 Gaston Ave
Ste 1000
Dallas, TX 75246
Phone (469) 800-9000

4001 Worth St
Dallas, TX 75246
Phone (214) 828-1745

8080 N Central Expy
Ste 600
Dallas, TX 75206
Phone (972) 860-8648

4001 Worth St
#A
Dallas, TX 75246
Phone (214) 820-8665

4700 Alliance Blvd
Ste 400
Plano, TX 75093
Phone (469) 814-6631

Interoperability endpoints

  • Direct secure messaging: ekim225958@direct.sw.org

Organizations & group practices 5

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 7

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": "1335139200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1672790400000",
    "number": "1871851220",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3417 GASTON AVE",
            "address_2": "SUITE 1000",
            "city": "DALLAS",
            "state": "TX",
            "postal_code": "752462016",
            "telephone_number": "469-800-9000",
            "fax_number": "469-800-9010"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3417 GASTON AVE",
            "address_2": "SUITE 1000",
            "city": "DALLAS",
            "state": "TX",
            "postal_code": "752462016",
            "telephone_number": "469-800-9000",
            "fax_number": "469-800-9010"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KIM",
        "first_name": "ELECIA",
        "middle_name": "EUNJU",
        "credential": "M.D. (MAY 2012)",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2012-04-23",
        "last_updated": "2023-01-04",
        "certification_date": "2023-01-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "TX",
            "license": "Q3533",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "ekim225958@direct.sw.org",
            "affiliation": "N",
            "address_1": "3417 Gaston Ave",
            "address_2": "Suite 1000",
            "city": "Dallas",
            "state": "TX",
            "country_code": "US",
            "postal_code": "752462016",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Dallas, TX

Sources for this page

Verify at the official NPI Registry.