Individual provider Active NPI

Kim Yen Thi Nguyen, MD

  • Family Medicine Physician
  • Scotts Valley, CA
National Provider Identifier
1902166952
Registry record updated Mar 17, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
A150879 Issued in CA
Practice address
5615 Scotts Valley Dr
Scotts Valley, CA 95066-3492
Phone
(831) 430-2700
NPI assigned
May 24, 2012
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 17, 2018

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 281084 NY
Student in an Organized Health Care Education/Training Program 390200000X
Family Medicine Physician 207Q00000X A150879 CA Primary

Addresses

Primary practice location

5615 Scotts Valley Dr
Scotts Valley, CA 95066-3492

Mailing address

5615 Scotts Valley Dr
Scotts Valley, CA 95066-3492
Phone (831) 430-2700

Other practice location 1

301 Prospect Ave
Medical Education
Syracuse, NY 13203-1807
Phone (315) 448-5537

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NY
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 1

Enrollment IDStateProvider typePAC IDDetails
I20151215002162 NY Practitioner - Family Practice 9133420276 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Other, 2011
Medicare assignment
May accept Medicare assignment
Group practices
Montefiore Medical CenterGroup PAC ID 3779496021, 2,809 clinicians

Practice addresses (Care Compare)

111 E 210TH St
Bronx, NY 10467-2401
Phone (866) 633-8255

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
100 of 100Reported as group
Promoting interoperability
100
Improvement activities
40

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
A150879CAMDFamily Medicine Physician
281084NYMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Montefiore Medical Center CurrentSince Oct 13, 2015 Accepting new patients
Montefiore Medical Center CurrentSince Oct 13, 2015 Accepting new patients

Locations

111 E 210th St
Bronx, NY 10467

1 Fordham Plz
Fl 5
Bronx, NY 10458
Phone (718) 741-9505

Networks

  • Healthfirst Medicare Network H9678
  • Healthfirst Medicare Network H1722
  • Healthfirst Medicare Network H3359
  • Healthfirst Medicare Network H5989

Interoperability endpoints

  • Direct secure messaging: knguye@montefioredirect.com

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 1

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": "1337817600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1521244800000",
    "number": "1902166952",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5615 SCOTTS VALLEY DR",
            "city": "SCOTTS VALLEY",
            "state": "CA",
            "postal_code": "950663492",
            "telephone_number": "831-430-2700"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5615 SCOTTS VALLEY DR",
            "city": "SCOTTS VALLEY",
            "state": "CA",
            "postal_code": "950663492",
            "telephone_number": "831-430-2700"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "301 Prospect Ave",
            "address_2": "Medical Education",
            "address_purpose": "LOCATION",
            "city": "Syracuse",
            "state": "NY",
            "postal_code": "132031807",
            "country_code": "US",
            "telephone_number": "315-448-5537",
            "fax_number": "315-448-6313",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "NGUYEN",
        "first_name": "KIM YEN",
        "middle_name": "THI",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2012-05-24",
        "last_updated": "2018-03-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "NY",
            "license": "281084",
            "primary": false
        },
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "CA",
            "license": "A150879",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Scotts Valley, CA

Sources for this page

Verify at the official NPI Registry.