RODERICK YOUNGDO KIM (DDS, MD) – Oral & Maxillofacial Surgery (D.M.D.), NPI 1689954562
Oral & Maxillofacial Surgery (D.M.D.)
Main info
Doctor Profile
Profile Insights
NPPES metrics only — not quality of care.
98 MAXILLOFACIAL SURGERY in TX
Provider Addresses for RODERICK YOUNGDO KIM (DDS, MD)
1500 SOUTH MAIN
DEPARTMENT OF OMFS
FORT WORTH, TX 76104
Phone:
Type: Mailing
1500 S MAIN ST DEPT OF
FORT WORTH, TX 761044917
Phone: (817) 702-6936
Type: Location
NPPES updates history
No NPPES updates recorded for this provider.
Prescription Activity
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Open Payments (CMS)
CMS reports 49 Open Payments records for all available years, with a total value of $4,627.
Total Amount is formed as General ($4,627) + Research ($0) + Ownership ($0) = $4,627.
Last reported payment date: 2024-10-09 • Largest payer in this snapshot: BioHorizons Implant Systems Inc. ($1,796).
Total Amount
$4,627
General + Research + Ownership
Payments
49
Total payment records
General Amount
$4,627
General payments
Research Amount
$0
Research funding
Ownership Amount
$0
Ownership interests
Ownership Count
0
Ownership records
Last Payment Date
2024-10-09
Latest reported date
Top Companies
Largest payers in this snapshot
| Company | Amount |
|---|---|
| BioHorizons Implant Systems Inc. | $1,796 |
| KLS-Martin L.P. | $1,191 |
| Geistlich Pharma, North America, Inc. | $649 |
| AXOGEN | $436 |
| Smith+Nephew, Inc. | $291 |
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: 2017-08-05
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 |
|---|---|---|---|---|
| I20170805000004 | I | Maxillofacial Surgery | 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.
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 76104)
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Group practice members
| Name | Specialty | State |
|---|---|---|
| Maxillofacial Surgery, Oral Surgery | TX | |
| - | TX | |
| Maxillofacial Surgery, Oral Surgery, Plastic And Reconstructive Surgery, Vascular Surgery | TX | |
| Oral Surgery | MI | |
| Oral Surgery | TX | |
| Oral Surgery | TX | |
| Maxillofacial Surgery | TX | |
| - | CA | |
| - | TX | |
| - | TX |
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