NPIMap

Individual provider Active NPI

Peter S. Kim, M.D.

  • Gastroenterology Physician
  • Highland, IL
National Provider Identifier
1942250030
Registry record updated Apr 6, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Gastroenterology PhysicianTaxonomy code 207RG0100X
License
036090402 Issued in IL
Practice address
821 Poplar St
Highland, IL 62249-1658
Phone
(618) 654-1281
Fax
(618) 654-1452
NPI assigned
May 11, 2006
Last updated
Apr 6, 2016By the provider in NPPES
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Apr 6, 2016

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Gastroenterology Physician 207RG0100X 036090402 IL Primary

Addresses

Primary practice location

821 Poplar St
Highland, IL 62249-1658

Mailing address

P.O. Box 9
Highland, IL 62249
Phone (618) 654-1281

Other identifiers 1

IdentifierTypeStateIssuer
213743OtherILPTAN

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IL
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
I20060714000073 IL Practitioner - GastroenterologyPractitioner - Internal Medicine 9739192808 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
GastroenterologyAlso: Internal Medicine
Education
University of Illinois College of Med (CHI/Peor/Rock/CHM-Urb), 1993
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
HSHS Medical Group IncGroup PAC ID 5092857821, 212 clinicians

Practice addresses (Care Compare)

1512 N Green Mount Rd
Suite 108
Ofallon, IL 62269-1953
Phone (618) 624-5510

200 Health Care Dr
Greenville, IL 62246-1154
Phone (618) 664-1230

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
94.81 of 100Reported as apm
Quality
85.98
Promoting interoperability
100
Improvement activities
40

Procedures performed for Medicare patients

ProcedureNumber of procedures
Colonoscopy269
Upper gastrointestinal (GI) endoscopy for acid reflux307

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
HSHS Medical Group Inc CurrentSince Apr 24, 2016 Accepting new patients
St Josephs Hospital of the Hospital Sisters of the Third Order of St F CurrentSince Jan 1, 2015 Accepting new patients
HSHS Medical Group CurrentSince Jan 1, 2015 Accepting new patients
HSHS Medical Group Inc CurrentSince Apr 24, 2016 Accepting new patients
HSHS Medical Group Inc Past Accepting new patients

Locations

211 S 3rd St
Belleville, IL 62220
Phone (618) 234-2700

200 Health Care Dr
Greenville, IL 62246
Phone (618) 664-0808

12866 Troxler Ave
Highland, IL 62249
Phone (618) 651-2600

821 Poplar St
Highland, IL 62249
Phone (618) 654-1281

1512 N Green Mount Rd
O Fallon, IL 62269
Phone (618) 624-0100

3051 Hollis Dr
Fl 2
Springfield, IL 62704
Phone (217) 321-9321

Interoperability endpoints

  • Direct secure messaging: greenvillegastro@dpskm-il.direct.office.nextgen.com

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

Hospital & facility affiliations 6

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": "1147305600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1459900800000",
    "number": "1942250030",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "P.O. BOX 9",
            "city": "HIGHLAND",
            "state": "IL",
            "postal_code": "62249",
            "telephone_number": "618-654-1281",
            "fax_number": "618-654-1452"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "821 POPLAR ST",
            "city": "HIGHLAND",
            "state": "IL",
            "postal_code": "622491658",
            "telephone_number": "618-654-1281",
            "fax_number": "618-654-1452"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KIM",
        "first_name": "PETER",
        "middle_name": "S.",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-05-11",
        "last_updated": "2016-04-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207RG0100X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Gastroenterology",
            "state": "IL",
            "license": "036090402",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PTAN",
            "identifier": "213743",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Highland, IL

Sources for this page

Verify at the official NPI Registry.