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 4

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.

Established patient office or other outpatient visit, 30-39 minutes 99214
This is a routine check-up for patients who have previously visited our clinic. It involves a comprehensive review of your health and any ongoing treatments. The consultation lasts between 30-39 minutes, allowing enough time to discuss any concerns.
12 services12 patients
New patient office or other outpatient visit, 45-59 minutes 99204
This is a first-time office or outpatient visit lasting between 45-59 minutes. The healthcare provider evaluates your health, discusses your medical history, and may suggest further tests or treatments. It's an opportunity to ask questions and understand your health better.
11 services11 patients
Melanoma (skin cancer) excision NAN03
Melanoma excision is a procedure where a surgeon removes melanoma, a type of skin cancer, and some surrounding healthy tissue. Local anesthesia is applied to numb the area. The goal is to completely remove the cancer and prevent its spread. Healing time varies.
0 services1 patient
Mastectomy NAN04
A mastectomy is a surgical procedure that involves the removal of all or part of the breast tissue. This is often done to treat or prevent conditions related to abnormal cell growth. There are different types, ranging from removing only the breast tissue to also removing nearby structures. The approach depends on individual health circumstances.
0 services1 patient

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.