Jerry J Kim, MD

Primary specialty

Vascular Surgery PhysicianTaxonomy code 2086S0129X

License

A124130 Issued in CA

Practice address

350 Vinton Ave Ste 202
Pomona, CA 91767-3000

Phone

(909) 909-1148

Fax

(909) 363-4954

NPI assigned

Jul 16, 2011

Last updated

Aug 1, 2023By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in CA

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

Specialty

General Surgery

Education

Baylor College of Medicine, 2011

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Jerry Kim MD IncGroup PAC ID 4082094479, 4 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Pomona Valley Hospital Medical Center Hospital, Pomona, CA, CCN 050231

Merit-based Incentive Payment System (MIPS)

Final score

75 of 100Reported as individual

Merit-based Incentive Payment System (MIPS)

Final score

78.08 of 100Reported as group

Quality

40.87

Promoting interoperability

75

Improvement activities

40

Cost

74.84

Procedures performed for Medicare patients

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

Networks

• BSC 65 PLUS INDIVIDUAL MAPD

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.

• Jerry Kim MD Inc

  • Vascular Surgery Physician
  • Pomona, CA
  • NPI 1093452278
  Medicare reassignment Care Compare group NPD Authorized official
• Pomona Valley Hospital Medical Center

  • General Acute Care Hospital
  • Pomona, CA
  • NPI 1518067586
  NPD (past)
• San Antonio Regional Hospital

  • General Acute Care Hospital
  • Upland, CA
  • NPI 1780681189
  NPD (past)
• Primecare Medical Group

  • Internal Medicine Physician
  • Tampa, FL
  • NPI 1093720427
  NPD (past)

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

• Pomona Valley Hospital Medical Center

  • General Acute Care Hospital
  • Pomona, CA
  • NPI 1407813660
  Care Compare affiliation

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1310774400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1690848000000",
    "number": "1912295510",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "350 VINTON AVE STE 202",
            "city": "POMONA",
            "state": "CA",
            "postal_code": "917673000",
            "telephone_number": "909-973-1148",
            "fax_number": "909-363-4954"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "350 VINTON AVE STE 202",
            "city": "POMONA",
            "state": "CA",
            "postal_code": "917673000",
            "telephone_number": "909-909-1148",
            "fax_number": "909-363-4954"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KIM",
        "first_name": "JERRY",
        "middle_name": "J",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2011-07-16",
        "last_updated": "2023-08-01",
        "certification_date": "2023-08-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208600000X",
            "taxonomy_group": "",
            "desc": "Surgery",
            "state": "CA",
            "license": "A124130",
            "primary": false
        },
        {
            "code": "2086S0129X",
            "taxonomy_group": "",
            "desc": "Surgery, Vascular Surgery",
            "state": "CA",
            "license": "A124130",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Eun Jung Kim
• Grace Mijung Kim
• Hae Kim
• Hannah Kim
• Heather Hyojin Kim, FNP
• Jong Hun Kim, MD
• Judy Kim
• Juliah Shay Kim
• Kwang Jib Kim, D.D.S.
• Kyungyeon Kim, RD

• Vascular Surgery Physician in Pomona, CA
• Providers in Pomona, CA by specialty
• Vascular Surgery Physician in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 1, 2023; 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.

Verify at the official NPI Registry.