JI MIN KIM – Gerontology Nurse Practitioner, NPI 1073960399
Gerontology Nurse Practitioner
Main info
Doctor Profile
Profile Insights
NPPES metrics only — not quality of care.
11,632 NURSE PRACTITIONER in IL
Provider Addresses for JI MIN KIM
2650 Ridge Ave
Evanston, IL 602011718
Phone: (847) 570-2000
Type: Location
680 North Lake Shore Drive, 680, North Lake Shore Drive, Streeterville, Near North Side, Chicago, Cook County, Illinois, 60611, United States
CHICAGO, IL 606114546
Phone: (312) 695-6868
Type: Mailing
GreenRiver, 259, East Erie Street, Magnificent Mile, Near North Side, Chicago, Cook County, Illinois, 60611, United States
CHICAGO, IL 606112987
Phone: (312) 695-4517
Type: Location
NPPES updates history
No NPPES updates recorded for this provider.
Prescription Activity
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Open Payments (CMS)
CMS reports 1 Open Payments records for all available years, with a total value of $78.
Total Amount is formed as General ($78) + Research ($0) + Ownership ($0) = $78.
Last reported payment date: 2024-05-08 • Largest payer in this snapshot: AXOGEN ($78).
Total Amount
$78
General + Research + Ownership
Payments
1
Total payment records
General Amount
$78
General payments
Research Amount
$0
Research funding
Ownership Amount
$0
Ownership interests
Ownership Count
0
Ownership records
Last Payment Date
2024-05-08
Latest reported date
Top Companies
Largest payers in this snapshot
| Company | Amount |
|---|---|
| AXOGEN | $78 |
Medicare Enrollment & Revalidation
Source: CMS public data · Not endorsed by CMS ·
Educational use only—not medical, billing, or legal advice.
PECOS enrollment status
Participating (accepts Medicare assignment)
Enrollment effective: 2016-08-01
PECOS data refreshed: 2026-05-27
Medicare revalidation (CMS due date list)
Due date not assigned yet
CMS is tracking this Medicare enrollment for revalidation, but has not published a due date.
Enrollment records
1
Earliest due date
Not assigned (TBD)
CMS data updated
2026-06-01
Revalidation progress
- Medicare enrolled
- On CMS revalidation list
- Due date assigned
- Revalidate in PECOS
CMS enrollment records
| Enrollment ID | Type | Specialty | State | Due date |
|---|---|---|---|---|
| I20160801001436 | I | Nurse Practitioner | IL | TBD |
What to do next
- No action required while the due date shows TBD.
- Check the CMS Revalidation Lookup Tool periodically — CMS updates the list about every 60 days.
- Do not submit a revalidation application in PECOS until CMS publishes a concrete due date.
Prepare CMS-855 application → · Look up this NPI in PECOS → · Verify on CMS PECOS
Medicare Utilization (FFS)
Source: CMS public data · Not endorsed by CMS · Beneficiary counts under 11 are suppressed in source data ·
Educational use only—not medical, billing, or legal advice.
No Medicare fee-for-service utilization data available for this provider in our database.
Insurance plans in this area (ZIP 60201)
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Group practice members
| Name | Specialty | State |
|---|---|---|
| - | IL | |
| Diagnostic Radiology, Interventional Radiology | IL | |
| P A T H O L O G Y | IL | |
| Interventional Cardiology, Cardiovascular Disease (Cardiology), Internal Medicine | IL | |
| G A S T R O E N T E R O L O G Y | IL | |
| Internal Medicine | IL | |
| Cardiac Electrophysiology, Cardiovascular Disease (Cardiology), Internal Medicine | MN | |
| - | IL | |
| Physical Therapist In Private Practice | IL | |
| Nurse Practitioner | IL |
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