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MYUNG-SUP KIM MD PA
NPI 1457311656
Specialist in Petersburg, WV

Active since March 23, 2006
RT 55 WEST, PETERSBURG, WV 26847(304) 257-1026 Get Directions Write a Review

NPPES record last updated: August 16, 2010. Verified against the NPPES registry weekly; last sync: October 25, 2026.

About Myung-sup Kim Md Pa NPPES

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

MYUNG-SUP KIM MD PA (NPI 1457311656) is a healthcare organization registered as a specialist in Petersburg, West Virginia and active in the NPI registry since March 2006. The organization lists Myung-sup Kim, President, as its authorized official.

NPPES Registry Identity

NPI1457311656
Entity TypeOrganization
Primary Taxonomy174400000X
Legal Business NameMYUNG-SUP KIM MD PA
Location AddressRT 55 WESTPetersburg, WV 26847
Mailing AddressPo Box 240Cumberland, MD 21501-0240 · (301) 724-1646 · Fax (301) 724-7429
Phone(304) 257-1026
Organization SubpartNo
Authorized OfficialMyung-sup KimPresident · (301) 724-1646
Enumeration DateMarch 23, 2006
Last NPPES UpdateAugust 16, 2010
✔ NPI 1457311656 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtySpecialistOther Service Providers
Taxonomy Code174400000X
Definition
An individual educated and trained in an applied knowledge discipline used in the performance of work at a level requiring knowledge and skills beyond or apart from that provided by a general education or liberal arts degree.
RT 55 WEST, Petersburg, WV 26847
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Other Identifiers 11

Medicare ID-Type Unspecified224MMD
Medicaid3810011406WV
Medicare ID-Type Unspecified9320761WV
Other001708869WV · Blue Shield
OtherS366MD · Federal Bs
Other1120362Mamsi
Medicaid991702100MD
Medicare PINDG2426
Other02059300Black Lung
OtherKCD4MD · Blue Shield
Medicare PINDG2425

Group Practice 1

Group TaxonomyThis provdier is a business group of one or more individual practitioners, all of who practice with the same area of specialization.193400000X SINGLE SPECIALTY GROUP

Medicare Participation & PECOS CMS

Medicare enrollment, revalidation and the clinicians who bill Medicare through this organization, from CMS.

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Myung-sup Kim Md Pa is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

Medicare Revalidation Due Date

Revalidation due by February 28, 2027

Medicare-enrolled providers and suppliers confirm their enrollment information with CMS on a set cycle, every 5 years for most and every 3 years for medical equipment suppliers. CMS sets the due date for each enrollment.

StateEnrollment IDDue date
StateMarylandEnrollment IDO20050405000224Non-DME Part B · Clinic/Group PracticeDue dateFebruary 28, 2027
Source: CMS Revalidation Due Date List, October 2026 release.

Clinicians Billing Medicare Through This Organization

Medicare enrollment records show 1 clinician reassigns Medicare billing to Myung-Sup Kim MD PA, which bills Medicare for the services this clinician delivers.

Clinician (1)

Myung Sup Kim, M.D.
Diagnostic Radiology
NPI 1306849492
952 SETON DR
Cumberland, MD 21502
(301) 777-3522
✔ PECOS✔ Accepts Medicare49 mi

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

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 Myung-Sup Kim MD PA's NPI number?

The NPI number for Myung-Sup Kim MD PA is 1457311656. It was assigned to this organization in the NPPES registry on March 23, 2006.

Where is Myung-Sup Kim MD PA located?

Myung-Sup Kim MD PA is located at Rt 55 West, Petersburg, WV 26847. The listed phone number is (304) 257-1026.

What is Myung-Sup Kim MD PA's specialty?

The primary specialty registered for this NPI is Specialist with taxonomy code 174400000X.

Is Myung-Sup Kim MD PA enrolled in Medicare?

Yes. Myung-Sup Kim MD PA is registered in the Medicare PECOS enrollment system.

When is Myung-Sup Kim MD PA's Medicare revalidation due?

According to the CMS Revalidation Due Date List (October 2026 release), the Medicare Non-DME Part B enrollment for this organization (Maryland, Clinic/Group Practice) is due for revalidation by February 28, 2027. Medicare providers and suppliers revalidate their enrollment every 5 years, and medical equipment suppliers every 3 years. Confirm current requirements with your Medicare Administrative Contractor.

How many clinicians bill Medicare through Myung-Sup Kim MD PA?

According to the CMS Revalidation Reassignment List (October 2026 release), 1 clinician (Diagnostic Radiology) reassigns their Medicare billing to Myung-Sup Kim MD PA. A 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 the clinician's services. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.

When was this NPI record last updated?

The NPPES record for Myung-Sup Kim MD PA was last updated on August 16, 2010. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 16 years 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.