Active NPI
Dianna Katherine Kim, MD
- Obstetrics & Gynecology Physician
- Vernon Hills, IL
National Provider Identifier
1962403006
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Obstetrics & Gynecology Physician
- License
- 036103945
- Practice address
- 250 Center Dr
Suite 101
Vernon Hills, IL 60061-1582 - Phone
- (847) 918-7050
- Fax
- (847) 918-7068
- NPI assigned
- Aug 10, 2005
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Obstetrics & Gynecology Physician | 207V00000X | 036103945 | IL | Primary |
Addresses
Primary practice location
250 Center Dr
Suite 101
Vernon Hills, IL 60061-1582
Mailing address
2801 Lakeside Dr Ste 209
Bannockburn, IL 60015-1271
Phone (847) 562-1410
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 036103945 | Medicaid | IL |
Electronic endpoints 2
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| Direct Messaging Address | dkim234712@direct.myadvocateaurora.org | Direct | |
| FHIR URL | https://epicfhir.aurora.org/FHIR/MYAURORA/api/FHIR/DSTU2/ |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in IL
- 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
- Obstetrics/Gynecology
- Education
- College of Medicine and Surgery, 1998
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
Practice addresses (Care Compare)
250 Ctr Dr
Suite 101
Vernon Hills, IL 60061-1582
Phone (847) 918-7050
801 S Milwaukee Ave
Libertyville, IL 60048-3204
Phone (847) 562-1410
Hospital & facility affiliations
- Advocate Condell Medical Center
- Northshore University Healthsystem - Evanston Hospital
- Northwestern Lake Forest Hospital
Procedures performed for Medicare patients
| Procedure | Number of procedures |
|---|---|
| Removal of the uterus | 1-10 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 036103945 | IL | MD | Obstetrics & Gynecology Physician |
Interoperability endpoints
- dianna.kim.1@21117.direct.athenahealth.com
Organizations & group practices 1
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.
-
- Obstetrics & Gynecology Physician
- Bannockburn, IL
- NPI 1447200654
Hospital & facility affiliations 5
Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.
-
- General Acute Care Hospital
- Libertyville, IL
- NPI 1124272547
-
- Mobile Mammography Clinic/Center
- Grayslake, IL
- NPI 1770737199
Hospital
-
- General Acute Care Hospital
- Evanston, IL
- NPI 1184670549
-
- General Acute Care Hospital
- Lake Forest, IL
- NPI 1124025176
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1123632000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1639958400000",
"number": "1962403006",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2801 LAKESIDE DR STE 209",
"city": "BANNOCKBURN",
"state": "IL",
"postal_code": "600151271",
"telephone_number": "847-562-1410",
"fax_number": "847-562-0830"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "250 CENTER DR",
"address_2": "SUITE 101",
"city": "VERNON HILLS",
"state": "IL",
"postal_code": "600611582",
"telephone_number": "847-918-7050",
"fax_number": "847-918-7068"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KIM",
"first_name": "DIANNA",
"middle_name": "KATHERINE",
"name_prefix": "Dr.",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2005-08-10",
"last_updated": "2021-12-20",
"certification_date": "2021-12-20",
"status": "A"
},
"taxonomies": [
{
"code": "207V00000X",
"taxonomy_group": "",
"desc": "Obstetrics & Gynecology",
"state": "IL",
"license": "036103945",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "036103945",
"state": "IL"
}
],
"endpoints": [
{
"endpointType": "DIRECT",
"endpointTypeDescription": "Direct Messaging Address",
"endpoint": "dkim234712@direct.myadvocateaurora.org",
"affiliation": "N",
"use": "DIRECT",
"useDescription": "Direct",
"address_1": "250 Center Dr",
"address_2": "Suite 101",
"city": "Vernon Hills",
"state": "IL",
"country_code": "US",
"postal_code": "600611582",
"country_name": "United States",
"address_type": "DOM"
},
{
"endpointType": "FHIR",
"endpointTypeDescription": "FHIR URL",
"endpoint": "https://epicfhir.aurora.org/FHIR/MYAURORA/api/FHIR/DSTU2/",
"affiliation": "N",
"address_1": "250 Center Dr",
"address_2": "Suite 101",
"city": "Vernon Hills",
"state": "IL",
"country_code": "US",
"postal_code": "600611582",
"country_name": "United States",
"address_type": "DOM"
}
],
"other_names": []
}Other providers in Vernon Hills, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 20, 2021; 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.