Active NPI
Miriam Grace Kim, D.O.
- Pediatric Hematology & Oncology Physician
- Indianapolis, IN
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pediatric Hematology & Oncology Physician
- License
- 02005955A
- Practice address
- 705 Riley Hospital Dr
Roc 4340
Indianapolis, IN 46202-5109 - Phone
- (317) 944-2143
- Fax
- (317) 944-3107
- NPI assigned
- Apr 11, 2012
- Sex
- Female
- Sole proprietor
- Yes
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 |
|---|---|---|---|---|
| Pediatric Hematology & Oncology Physician | 2080P0207X | 63854-21 | WI | |
| Pediatric Hematology & Oncology Physician | 2080P0207X | 02005955A | IN | Primary |
Addresses
Primary practice location
705 Riley Hospital Dr
Roc 4340
Indianapolis, IN 46202-5109
Mailing address
PO Box 719094
Chicago, IL 60677-9318
Phone (317) 777-6435
Other practice location 1
420 Delaware St SE
MCRB, Suite 660 MMC 366
Minneapolis, MN 55455-0341
Phone (612) 624-3113
Other practice location 2
2525 Chicago Ave
Minneapolis, MN 55404-4518
Phone (312) 752-8176
Other practice location 3
600 Highland Ave
Madison, WI 53792-0001
Phone (608) 263-8556
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 300036343 | Medicaid | IN |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in IN
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: Yes
Enrollment records 1
Care Compare profile
Medicare Care Compare- Specialty
- Hematology/Oncology
- Education
- Other, 2012
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
Practice addresses (Care Compare)
705 Riley Hospital Dr
Indianapolis, IN 46202-5109
Phone (317) 944-5000
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Osteopathy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 02005955A | IN | MD | Pediatric Hematology & Oncology Physician |
| 63854-21 | WI | MD | Pediatric Hematology & Oncology Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| University Pediatric Associates, Inc. | Current | Accepting new patients | |
| Iu Health Medical Group Riley Specialists, LLC | Current | Accepting new patients |
Locations
705 Riley Hospital Dr
#4340
Indianapolis, IN 46202
Phone (317) 944-2143
705 Riley Hospital Dr
Indianapolis, IN 46202
Phone (317) 274-4779
Interoperability endpoints
- mkim5@direct.iuhealth.org
Organizations & group practices 2
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.
-
- Pediatrics Physician
- Indianapolis, IN
- NPI 1699561480
-
- Pediatrics Physician
- Indianapolis, IN
- NPI 1457396541
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1334102400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1771027200000",
"number": "1891052171",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 719094",
"city": "CHICAGO",
"state": "IL",
"postal_code": "606779318",
"telephone_number": "317-777-6435",
"fax_number": "317-777-6644"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "705 RILEY HOSPITAL DR",
"address_2": "ROC 4340",
"city": "INDIANAPOLIS",
"state": "IN",
"postal_code": "462025109",
"telephone_number": "317-944-2143",
"fax_number": "317-944-3107"
}
],
"practiceLocations": [
{
"address_1": "420 Delaware St SE",
"address_2": "MCRB, Suite 660 MMC 366",
"address_purpose": "LOCATION",
"city": "Minneapolis",
"state": "MN",
"postal_code": "554550341",
"country_code": "US",
"telephone_number": "612-624-3113",
"country_name": "United States",
"address_type": "DOM"
},
{
"address_1": "2525 Chicago Ave",
"address_purpose": "LOCATION",
"city": "Minneapolis",
"state": "MN",
"postal_code": "554044518",
"country_code": "US",
"telephone_number": "312-752-8176",
"country_name": "United States",
"address_type": "DOM"
},
{
"address_1": "600 Highland Ave",
"address_purpose": "LOCATION",
"city": "Madison",
"state": "WI",
"postal_code": "537920001",
"country_code": "US",
"telephone_number": "608-263-8556",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "KIM",
"first_name": "MIRIAM",
"middle_name": "GRACE",
"credential": "D.O.",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2012-04-11",
"last_updated": "2026-02-14",
"certification_date": "2026-02-14",
"status": "A"
},
"taxonomies": [
{
"code": "2080P0207X",
"taxonomy_group": "",
"desc": "Pediatrics, Pediatric Hematology-Oncology",
"state": "WI",
"license": "63854-21",
"primary": false
},
{
"code": "2080P0207X",
"taxonomy_group": "",
"desc": "Pediatrics, Pediatric Hematology-Oncology",
"state": "IN",
"license": "02005955A",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "300036343",
"state": "IN"
}
],
"endpoints": [],
"other_names": []
}
Other providers in Indianapolis, IN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 14, 2026; 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.