MICHAEL KIM (MD) – Diagnostic Radiology Physician, NPI 1578751400

Diagnostic Radiology Physician

MICHAEL KIM (MD) is a healthcare provider. based in Dallas, Texas. specializing in DIAGNOSTIC RADIOLOGY. They hold the professional credentials MD. They hold a License No. A104900 (CA). The NPI Number for MICHAEL KIM (MD) is 1578751400

Main info

Male

Sole Proprietor

19 Years Of Experience

Accepts Medicare Assignment

Name

MICHAEL KIM (MD)

NPI

1578751400

Phone

(254) 724-2111

Address

PO BOX 844658

Enumeration Date

4 October 2007

Last Update Date

18 November 2020

Doctor Profile

Medical School Name

JS WEILL MEDICAL COLLEGE, CORNELL UNIVERSITY

Secondary Phone

8004753698

Graduation Year

2007 (19 years ago)

PAC ID

6608032180

Group Practice PAC ID

5698729044

Professional Enrollment ID

I20130801000392

Address ID

TX782304434SA9110XSTXX300

Contacts

Secure Messaging

mkim207199@direct.sw.org

Data current as of

19 May 2026

Profile Insights

NPPES metrics only — not quality of care.

Methodology

Experience69

Completeness85

Years active:18State licenses:2Other namesUpdated within 12 months

3,303 DIAGNOSTIC RADIOLOGY in TX

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Provider Addresses for MICHAEL KIM (MD)

Band Box Place, Dallas, Dallas County, Texas, 75244, United States
DALLAS, TX 752844658
Phone: (254) 724-2111
Fax: (254) 724-7603
Type: Mailing
Baylor Scott & White Medical Center – Round Rock, 300, University Boulevard, Round Rock, Williamson County, Texas, 78665, United States
ROUND ROCK, TX 786651032
Phone: (512) 509-0100
Fax: (512) 218-6330
Type: Location

NPPES updates history

No NPPES updates recorded for this provider.

Prescription Activity

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Open Payments (CMS)

No Open Payments data available for this provider.

This can happen when there are no reportable CMS Open Payments records.

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: 2013-08-01

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

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
I20130801000392	I	Diagnostic Radiology	TX	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.

Verify on CMS Revalidation Lookup Tool

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 75284)

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Group practice members

Group practice members are other physicians who share the same Group Practice PAC ID with this doctor. When doctors form a group practice and register in PECOS as a single entity, they receive a shared identification number. This table lists all providers in the same group practice.

PAC ID: 5698729044View full group profile