Ray S Kim, PHD

Primary specialty

PsychologistTaxonomy code 103T00000X

License

071-005373 Issued in IL

Practice address

500 Coventry LN
Suite 205
Crystal Lake, IL 60014-7579

Phone

(815) 455-7100

Fax

(815) 455-3951

NPI assigned

Jul 19, 2005

Last updated

Jul 5, 2012By 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 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in IL

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Clinical Psychologist

Education

Other, 1994

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Walking Together Therapy Associates PCGroup PAC ID 1557844768, 5 clinicians

Patrick J Kennelly and Associates P CGroup PAC ID 2860425113, 6 clinicians

Horizons Behavioral Health LLCGroup PAC ID 4385531672, 11 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Philosophy

State licenses

Practice roles

Locations

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.

• Horizons Behavioral Health LLC

  • Social Worker
  • Crystal Lake, IL
  • NPI 1881692689
  Medicare reassignment Care Compare group NPD
• Patrick J Kennelly and Associates P C

  • Clinical Psychologist
  • Schaumburg, IL
  • NPI 1750430476
  Medicare reassignment Care Compare group NPD
• Walking Together Therapy Associates PC

  • Group Psychotherapy Psychologist
  • Schaumburg, IL
  • NPI 1932062429
  Medicare reassignment Care Compare group NPD

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

{
    "created_epoch": "1121731200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1341446400000",
    "number": "1912906116",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "500 COVENTRY LN",
            "address_2": "SUITE 205",
            "city": "CRYSTAL LAKE",
            "state": "IL",
            "postal_code": "600147579",
            "telephone_number": "815-455-7100",
            "fax_number": "815-455-3951"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "500 COVENTRY LN",
            "address_2": "SUITE 205",
            "city": "CRYSTAL LAKE",
            "state": "IL",
            "postal_code": "600147579",
            "telephone_number": "815-455-7100",
            "fax_number": "815-455-3951"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KIM",
        "first_name": "RAY",
        "middle_name": "S",
        "credential": "PHD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-07-19",
        "last_updated": "2012-07-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103T00000X",
            "taxonomy_group": "",
            "desc": "Psychologist",
            "state": "IL",
            "license": "071-005373",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "05619771",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Nitin Kher
• Jalaluddin Khimani, D.D.S.
• Kidney Care Center Elgin LLC
• Gene Kim
• Hae Kyun Kim
• Steve J Kim, MA, LCPC
• Rachel R Kinnas, WHNP-BC
• Katharina Klakus
• Jacob Allen Klaustermeier, PAC
• Lilliana Klay, LCSW

• Psychologist in Crystal Lake, IL
• Providers in Crystal Lake, IL by specialty
• Psychologist in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 5, 2012; 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.