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JAEYOUNG KIM MD
NPI 1053016709
Orthopaedic Surgery - Foot and Ankle Surgery in Boston, MA

Active since April 03, 2023PECOS Enrolled

NPPES record last updated: January 8, 2025. Verified against the NPPES registry weekly; last sync: October 18, 2026.

Record update history: Jan 8, 2025, Apr 3, 2023 (2 updates tracked since 2023).

About Jaeyoung Kim Md NPPES

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

JAEYOUNG KIM MD (NPI 1053016709) is an individual foot and ankle surgery provider in Boston, Massachusetts, licensed in Massachusetts (3015846) and active in the NPI registry since April 2023. He is enrolled in Medicare PECOS and is a graduate of Other (2010).

NPPES Registry Identity

NPI1053016709
Entity TypeIndividualMale
Primary Taxonomy207XX0004X
Provider Legal NameJAEYOUNG KIMCredential: MD
Location Address55 FRUIT STBoston, MA 02114-2696
Mailing Address265 E 66th St Apt 11dNew York, NY 10065-6490 · (646) 946-7971
Phone(617) 726-2000
Sole ProprietorNo
Medical School CMSOtherGraduated 2010
Enumeration DateApril 3, 2023
Last NPPES UpdateJanuary 8, 20252 updates tracked since enumeration
NPPES CertifiedJanuary 8, 2025
✔ NPI 1053016709 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 2

★ Primary SpecialtyOrthopaedic Surgery · Foot and Ankle SurgeryAllopathic & Osteopathic Physicians
Taxonomy Code207XX0004X
License✔ Licensed in MA · 3015846
Definition
Recognized by several state medical boards as a fellowship subspecialty program of orthopaedic surgery, foot and ankle surgeons deal with adult reconstructive foot and ankle surgery, adult foot and ankle trauma, sports medicine foot and ankle, and children's foot and ankle reconstructive surgery.
Also ListedStudent in an Organized Health Care Education/Training ProgramTaxonomy 390200000X
55 FRUIT ST, Boston, MA 02114
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Medicare Participation & PECOS CMS

Medicare enrollment, assignment, billing reassignment, and ordering and referring status from CMS.

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Jaeyoung Kim Md is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

PECOS PAC ID5092173047
PECOS Enrollment IDI20260611003381
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.

Medicare Billing Reassignment

Medicare enrollment records show Jaeyoung Kim reassigns Medicare billing to 1 organization. The organization bills Medicare for the services this provider delivers there.

Ny Society For The Relief Of Ruptured & Crippled Maintaining
186 mi
Orthopaedic Surgery
535 E 70TH ST
New York, NY 10021
  • Reassigned Medicare billing, New York enrollment
  • 196 clinicians in this Medicare group
NPI 1902243488 (212) 774-7598

Source: CMS Revalidation Reassignment List, October 2026 release. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.

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.

STUTI GIRISH SHROFF MD, MBBS
Pathology (Anatomic Pathology)
55 FRUIT ST
BOSTON, MA 02114
Suffolk County (617) 726-2971
NANCY WANG M.D.
Internal Medicine (Hematology & Oncology)
55 FRUIT ST
BOSTON, MA 02114
Suffolk County (017) 724-4000
DR. DUSAN HANIDZIAR M.D., PH.D.
Anesthesiology
55 FRUIT ST, GRAY-BIGELOW 444
BOSTON, MA 02114
Suffolk County (617) 726-3030
JOHN JOSEPH DANKO DO
Physical Medicine & Rehabilitation
55 FRUIT ST
BOSTON, MA 02114
Suffolk County (617) 726-2000
DR. MICHAEL ANDREW LOBRITZ M.D, PH.D.
Internal Medicine (Infectious Disease)
55 FRUIT ST, DIVISION OF INFECTIOUS DISEASE, GRJ-504
BOSTON, MA 02114
Suffolk County (617) 724-9248
MS. KELLY ELISHA TRECARTIN NP
Nurse Practitioner (Acute Care)
55 FRUIT ST, BIGALOW 852 F
BOSTON, MA 02114
Suffolk County (617) 726-7400
JAMIE MARIE ALLEN NP
Nurse Practitioner
55 FRUIT ST
BOSTON, MA 02114
Suffolk County (617) 724-4410
DR. DHAVAL SANJEEV KOLTE M.B.B.S., PH.D.
Internal Medicine (Cardiovascular Disease)
55 FRUIT ST
BOSTON, MA 02114
Suffolk County (617) 643-3238

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Jaeyoung Kim's NPI number?

The NPI number for Jaeyoung Kim is 1053016709. It was assigned to this individual provider in the NPPES registry on April 3, 2023.

Where is Jaeyoung Kim located?

Jaeyoung Kim practices at 55 Fruit St, Boston, MA 02114. The listed phone number is (617) 726-2000.

What is Jaeyoung Kim's specialty?

The primary specialty registered for this NPI is Orthopaedic Surgery, specializing in Foot and Ankle Surgery, with taxonomy code 207XX0004X.

Is Jaeyoung Kim enrolled in Medicare?

Yes. Jaeyoung Kim is registered in the Medicare PECOS enrollment system.

Which organization bills Medicare for Jaeyoung Kim's services?

According to the CMS Revalidation Reassignment List (October 2026 release), Jaeyoung Kim reassigns Medicare benefits to Ny Society For The Relief Of Ruptured & Crippled Maintaining (New York, NY). The reassignment is filed with Medicare on form CMS-855R, signed by both the clinician and the organization, and lets the organization bill Medicare and receive payment for Jaeyoung Kim's services. Reassignment records can lag staffing changes; confirm current arrangements with the organization.

When was this NPI record last updated?

The NPPES record for Jaeyoung Kim was last updated on January 8, 2025. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 21 months ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.