Individual provider Active NPI

Im S Yi, M.D.

  • Family Medicine Physician
  • Kent, WA
National Provider Identifier
1992796650
Registry record updated May 12, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
MD00047267 Issued in WA
Practice address
26004 104TH Ave SE
Kent, WA 98030-7677
Phone
(425) 251-4040
NPI assigned
Nov 2, 2005
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 12, 2021

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 01055784 IN
Family Medicine Physician 207Q00000X MD00047267 WA Primary

Addresses

Primary practice location

26004 104TH Ave SE
Kent, WA 98030-7677

Mailing address

26004 104TH Ave SE
Kent, WA 98030-7677
Phone (425) 251-4040

Other identifiers 2

IdentifierTypeStateIssuer
8497141MedicaidWA
000000373612OtherINANTHEM

Electronic endpoints 1

TypeEndpointUseAffiliation
SOAP URL https://careepicwa.kp.org:14430/Interconnect-CE-PRD/wcf/epic.community.hie/xcpdrespondinggatewaysync Health Information Exchange (HIE)

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WA
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
I20071127000168 WA Practitioner - Family Practice 6507808375 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Other, 1999
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices

Practice addresses (Care Compare)

26004 104TH Ave SE
Suite 101
Kent, WA 98030-7677
Phone (425) 251-4050

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
MD00047267WAMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Kaiser Foundation Health Plan of Washington CurrentSince Nov 7, 2006 Accepting new patients
Kaiser Foundation Health Plan of Washington CurrentSince Nov 7, 2006 Accepting new patients
Kaiser Foundation Health Plan of Washington PastSince May 16, 2021 Accepting new patients
Board of Trustees of Howard Community Hospital Family Medicine Past Accepting new patients

Locations

26004 104th Ave SE
Ste 101
Kent, WA 98030
Phone (425) 251-4040

611 31st Ave SW
Puyallup, WA 98373
Phone (253) 445-7100

200 15th Ave E
Seattle, WA 98112
Phone (206) 326-4530

9505 S Steele St
Tacoma, WA 98444
Phone (253) 597-6800

209 Martin Luther King Jr Way
Tacoma, WA 98405
Phone (253) 596-3300

Interoperability endpoints

  • Direct secure messaging: iyi58281@ghc.direct-ci.net

Organizations & group practices 4

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.

NPI Registry JSON

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

{
    "created_epoch": "1130889600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1620777600000",
    "number": "1992796650",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "26004 104TH AVE SE",
            "city": "KENT",
            "state": "WA",
            "postal_code": "980307677",
            "telephone_number": "425-251-4040"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "26004 104TH AVE SE",
            "city": "KENT",
            "state": "WA",
            "postal_code": "980307677",
            "telephone_number": "425-251-4040"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "YI",
        "first_name": "IM",
        "middle_name": "S",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2005-11-02",
        "last_updated": "2021-05-12",
        "certification_date": "2021-05-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "IN",
            "license": "01055784",
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "WA",
            "license": "MD00047267",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "8497141",
            "state": "WA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ANTHEM",
            "identifier": "000000373612",
            "state": "IN"
        }
    ],
    "endpoints": [
        {
            "endpointType": "SOAP",
            "endpointTypeDescription": "SOAP URL",
            "endpoint": "https://careepicwa.kp.org:14430/Interconnect-CE-PRD/wcf/epic.community.hie/xcpdrespondinggatewaysync",
            "affiliation": "N",
            "endpointDescription": "Carequality",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "C-CDA",
            "address_1": "26004 104th Ave SE",
            "city": "Kent",
            "state": "WA",
            "country_code": "US",
            "postal_code": "980307677",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Kent, WA

Sources for this page

Verify at the official NPI Registry.