SAMUEL CHAN KIM (MD) – Urology Physician, NPI 1134129679
Urology Physician
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Doctor Profile
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Profile Insights
NPPES metrics only — not quality of care.
300 UROLOGY in IN
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Provider Addresses for SAMUEL CHAN KIM (MD)
2525, West University Avenue, Muncie, Delaware County, Indiana, 47303, United States
SUITE 504
MUNCIE, IN 473033421
Phone: (765) 289-7444
Fax: (765) 289-8628
Type: Mailing
5165 MCCARTY LN
LAFAYETTE, IN 479058764
Phone: (765) 448-8000
Fax: (765) 448-7619
Type: Location
2525 W University Ave
Suite 504
Muncie, IN 473033421
Phone: (765) 289-7444
Fax: (765) 289-8628
Type: Location
5177 McCarty Ln
Lafayette, IN 479058764
Phone: (765) 448-8000
Fax: (765) 448-7619
Type: Location
2401 W University Ave
Muncie, IN 473033428
Phone: (765) 741-1515
Type: Location
250 N SHADELAND AVE
INDIANAPOLIS, IN 462194959
Phone:
Type: Mailing
NPPES updates history
No NPPES updates recorded for this provider.
Prescription Activity
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Open Payments (CMS)
CMS reports 3 Open Payments records for all available years, with a total value of $124.
Total Amount is formed as General ($124) + Research ($0) + Ownership ($0) = $124.
Last reported payment date: 2024-12-13 • Largest payer in this snapshot: Axonics, Inc. ($66).
Total Amount
$124
General + Research + Ownership
Payments
3
Total payment records
General Amount
$124
General payments
Research Amount
$0
Research funding
Ownership Amount
$0
Ownership interests
Ownership Count
0
Ownership records
Last Payment Date
2024-12-13
Latest reported date
Top Companies
Largest payers in this snapshot
| Company | Amount |
|---|---|
| Axonics, Inc. | $66 |
| Boston Scientific Corporation | $58 |
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: 2004-08-14
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 |
|---|---|---|---|---|
| I20040814000095 | I | Urology | IN | 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.
Top Medicare procedures (2023) · refreshed 2026-05-27
| HCPCS | Description | Services | Beneficiaries | Medicare allowed |
|---|---|---|---|---|
| 99214 | Established patient office or other outpatient visit, 30-39 minutes | 32 | 31 | $0 |
| 99204 | New patient office or other outpatient visit, 45-59 minutes | 31 | 31 | $0 |
| 51798 | Ultrasound measurement of bladder capacity after voiding | 19 | 16 | $0 |
| 99213 | Established patient office or other outpatient visit, 20-29 minutes | 18 | 18 | $0 |
| 74420 | Imaging of urinary tract following injection of a contrast agent | 15 | 12 | $0 |
Insurance plans in this area (ZIP 47303)
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Provider's Procedures
Group practice members
| Name | Specialty | State |
|---|---|---|
| Nurse Practitioner | IN | |
| Nephrology, Internal Medicine | IN | |
| General Surgery | MI | |
| - | OH | |
| Family Practice | IN | |
| H E M A T O L O G Y/ O N C O L O G Y | NC | |
| Infectious Disease, Internal Medicine | NJ | |
| Cardiovascular Disease (Cardiology), Internal Medicine | IN | |
| Clinical Social Worker | IN | |
| - | IN |
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