MARY T KIM M.D.
NPI 1033192828
Surgery - Plastic and Reconstructive Surgery in Shreveport, LA

Active since November 25, 2005PECOS EnrolledAccepts Medicare Assignment
1501 KINGS HWY, SHREVEPORT, LA 71103(318) 675-6154 Get Directions Write a Review

NPPES record last updated: May 18, 2009. Verified against the NPPES registry weekly; last sync: July 19, 2026.

About Mary T Kim M.d. NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

MARY T KIM M.D. (NPI 1033192828) is an individual plastic and reconstructive surgery provider in Shreveport, Louisiana, licensed in Louisiana (MD200563) and active in the NPI registry since November 2005. She is enrolled in Medicare PECOS, is affiliated with Willis Knighton Medical Center, and is a graduate of Tufts University School Of Medicine (1997).

NPPES Registry Identity

NPI1033192828
Entity TypeIndividualFemale
Primary Taxonomy2086S0122X
Provider Legal NameMARY T KIMCredential: M.D.
Location Address1501 KINGS HWYShreveport, LA 71103-4228
Mailing Address1501 Kings HwyShreveport, LA 71103-4228 · (318) 675-6154
Sole ProprietorYes
Medical School CMSTufts University School Of MedicineGraduated 1997
Enumeration DateNovember 25, 2005
Last NPPES UpdateMay 18, 2009
NPI 1033192828 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

Primary SpecialtySurgery · Plastic and Reconstructive SurgeryAllopathic & Osteopathic Physicians
Taxonomy Code2086S0122X
License Licensed in LA · MD200563
Definition

A surgeon who specializes in plastic and reconstructive surgery.

1501 KINGS HWY, Shreveport, LA 71103

Other Identifiers 3

Medicare PIN4K020LA
Medicare UPINI48330LA
Medicaid1581518LA

Accepted Insurance

Medicare Participation & PECOS CMS

Medicare enrollment, assignment, and ordering and referring status from the CMS PECOS system.

Medicare Enrollment Status

Enrolled in Medicare and accepts Medicare assignment

Mary T Kim M.d. is registered in PECOS and agrees to accept the Medicare-approved amount as full payment. Medicare patients are not billed beyond the standard deductible and coinsurance.

PECOS PAC ID7618991316
PECOS Enrollment IDI20060120000623
Eligible to Order & Refer Part B Labs & Imaging Durable Medical Equipment Home Health Agency Power Mobility DevicesPer the CMS Ordering and Referring file. Eligibility means Medicare pays claims that this provider orders or refers for these categories.

Areas of Expertise CMS Part B claims

Services this provider delivered to Medicare fee-for-service patients, from the 2024 & 2026 CMS Medicare utilization data. Higher counts generally reflect more experience with a service; care delivered outside Medicare is not included.

New patient office or other outpatient visit with straightforward medical decision making, if using time, 15 minutes or more 99202
This service involves an initial visit to the doctor's office or other outpatient setting. It typically lasts between 15-29 minutes. The doctor will review your medical history, conduct a physical examination, and discuss your health concerns. It's a chance to establish your health baseline and address any immediate medical issues.
23 services23 patients

Hospital Affiliations CMS Care Compare

Hospitals where this provider delivers care, identified from recent Medicare claims and place-of-service records.

Willis Knighton Medical Center

Acute Care Hospitals · Shreveport, LA
3/5 CMS rating
OwnershipVoluntary non-profit - Private
CMS Certification Number190111
Location2600 Greenwood RoadShreveport, LA 71103 · Caddo County
Emergency services Birthing friendly

Other Providers at the Same Location NPPES 20

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

Physician Assistant
1501 KINGS HWY, DEPT. OF NEUROSURGERY
SHREVEPORT, LA 71103
Anesthesiology
1501 KINGS HWY, DEPARTMENT OF ANESTHESIA
SHREVEPORT, LA 71103
Physician Assistant
1501 KINGS HWY
SHREVEPORT, LA 71103
Surgery
1501 KINGS HWY, LSUHSC-S DEPARTMENT OF SURGERY
SHREVEPORT, LA 71103
Counselor
1501 KINGS HWY, LSUHSC-S DEPARMTENT OF PSYCHIATRY
SHREVEPORT, LA 71103
Family Medicine
1501 KINGS HWY, DEPARTMENT OF FAMILY MEDICINE
SHREVEPORT, LA 71103
Psychiatry & Neurology (Neurology)
1501 KINGS HWY, DEPARTMENT OF NEUROLOGY
SHREVEPORT, LA 71103
Psychiatry & Neurology (Neurology)
1501 KINGS HWY, DEPARTMENT OF NEUROLOGY
SHREVEPORT, LA 71103

Frequently Asked Questions

The NPI number assigned to this healthcare provider is 1033192828, enumerated as an "individual" on November 25, 2005.

The provider is located at 1501 KINGS HWY SHREVEPORT, LA 71103 and the phone number is (318) 675-6154.

Surgery with taxonomy code 2086S0122X and a focus in Plastic and Reconstructive Surgery.

The provider might be accepting Accepts: Ambetter from Arkansas Health & Wellness, Ambetter. Please consult your insurance carrier or call the provider to verify.

Mary Kim is affiliated with: WILLIS KNIGHTON MEDICAL CENTER.