Physician Compare National (NPI:1609289636)

HEALTHCARE PROVIDER: MICHAEL JIN KIM M.D.

Physician Compare National contains general information about individual eligible professionals (EPs) such as demographic information and Medicare quality program participation.

Individual Professional Information
NPI	1609289636
	Unique healthcare provider (clinician) ID assigned by NPPES
PECOS UID	8527284389
	Unique individual clinician ID assigned by PECOS
Professional Enrollment ID	I20171212003280
	Unique ID for the individual professional enrollment that is the source for the data in the observation
Provider Last Name	KIM
	Individual professional last name
Provider First Name	MICHAEL
	Individual professional first name
Provider Middle Name	JIN
	Individual professional middle name
Provider Gender	M
	The provider's gender if the provider is a person.

Medical School Information
Medical School Name	UNIFORMED SERVICES UHS FE HEBERT SCHOOL OF MED
	Individual professional's medical school
Graduation Year	2014
	Individual professional's medical school graduation year
Primary Specialty	FAMILY MEDICINE
	Primary medical specialty reported by the individual professional in the selected enrollment

Practice Information
Organization Legal Name	VITUITY ILLINOIS AUC LLP
	Legal name of the Group Practice that the individual professional works with- will be blank if the address is not linked to a Group Practice
Group Practice PAC ID	0547516932
	Unique Group Practice ID assigned by PECOS to the Group Practice that the individual professional works with- will be blank if the address is not linked to a Group Practice
Number of Group Practice members	46
	Total number of individual professionals affiliated with the Group Practice based on Group Practice PAC ID
Line 1 Street Address	900 W TEMPLE AVE
	Group Practice or individual's line 1 address
Line 2 Street Address	BLDG B
	Group Practice or individual's line 2 address
City	EFFINGHAM
	Group Practice or individual's city
State	IL
	Group Practice or individual's state
Zip Code	624012121
	Group Practice or individual's zip code (9 digits when available)
Phone Number	2173471690
	Phone number is listed only when there is a single phone number available for the practice location address

Hospital(s) Affiliation Information
Hospital Affiliation CCN 1	140187
	Medicare CCN of hospital where individual professional provides service 1
Hospital Affiliation LBN 1	HSHS ST ELIZABETH'S HOSPITAL
	Legal business name of hospital where individual professional provides service 1
Professional Accepts Medicare Assignment	Y