RODERICK YOUNGDO KIM DDS, MD
NPI 1689954562
Oral & Maxillofacial Surgery in Fort Worth, TX

NPI Status: Active since August 23, 2011

Contact Information

1500 S MAIN ST DEPT OF
FORT WORTH, TX
ZIP 76104
Phone: (817) 702-6936

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  • Individual
  • Male
  • Years of Experience 11
  • Oral & Maxillofacial Surgery
  • Accepts Insurance
  • Accepts Medicare Approved Payment
  • PECOS Enrolled

About RODERICK KIM

This page provides the complete NPI Profile along with additional information for Roderick Kim, a provider established in Fort Worth, Texas with a medical specialization in Oral & Maxillofacial Surgery and more than 11 years of experience. He graduated from University Of Michigan Medical School in 2015. The healthcare provider is registered in the NPI registry with number 1689954562 assigned on August 2011. The practitioner's primary taxonomy code is 204E00000X with license number 32838 (TX). The provider is registered as an individual and his NPI record was last updated one year ago. The organization operates as a single speciality business group with one or more individual providers who practice the same area of specialization.

NPI
1689954562
Provider Name
RODERICK YOUNGDO KIM DDS, MD
Gender
Male
Entity Type
Individual
Location Address
1500 S MAIN ST DEPT OF FORT WORTH, TX 76104
Location Phone
(817) 702-6936
Mailing Address
1500 SOUTH MAIN DEPARTMENT OF OMFS FORT WORTH, TX 76104
Medical School Name
UNIVERSITY OF MICHIGAN MEDICAL SCHOOL
Graduation Year
2015
Is Sole Proprietor?
Yes
Enumeration Date
08-23-2011
Last Update Date
06-26-2024
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Specialty - Primary Taxonomy

The NPI enumerator requires providers to submit at least one taxonomy code. A taxonomy code is a unique 10-character code that describes the healthcare provider type, classification, and the area of specialization. There could be only one primary taxonomy code per NPI record. For individual NPIs the license data is associated to the taxonomy code.

Classification

Oral & Maxillofacial Surgery

Taxonomy Code
204E00000X
Type
Allopathic & Osteopathic Physicians
License No.
32838
License State
TX
Taxonomy Description
Oral and maxillofacial surgeons are trained to recognize and treat a wide spectrum of diseases, injuries and defects in the head, neck, face, jaws and the hard and soft tissues of the oral and maxillofacial region. They are also trained to administer anesthesia, and provide care in an office setting. They are trained to treat problems such as the extraction of wisdom teeth, misaligned jaws, tumors and cysts of the jaw and mouth, and to perform dental implant surgery.

Secondary Taxonomies

The provider has reported to the NPI enumerator additional taxonomy codes. Multiple taxonomy codes may represent subspecialties or other areas of specialization the provider maybe licensed to practice.

No. Taxonomy Code Type Classification /
Specialization
License No. (State)
11223S0112XDental Providers

Dentist
Oral and Maxillofacial Surgery

32838 (TX)

Group Taxonomy 193400000X SINGLE SPECIALTY GROUP

This provdier is a business group of one or more individual practitioners, all of who practice with the same area of specialization.

Insurance Plans Accepted

According to publicly available information the provider might be accepting the following health plans from these health insurance companies:

  • Gold 10 Advanced: $0 PCP + Aetna network + $0 walk-in clinic + Adult Dental + Vision - HMO
  • Gold 3 Advanced: Aetna network + $0 walk-in clinic + Adult Dental + Vision - HMO
  • Silver 10 Advanced: $0 PCP + Aetna network + $0 walk-in clinic + Adult Dental + Vision - HMO
  • Silver S: Aetna network + $0 walk-in clinic + $0 CVS Health Virtual Care 24/7 + Adult Dental+Vision - HMO
  • Choice Bronze HSA - HMO
  • Choice Bronze HSA + Vision + Adult Dental - HMO
  • Clear Silver - HMO
  • Complete Gold - HMO
  • Complete Gold + Vision + Adult Dental - HMO
  • Complete Silver - HMO
  • Complete Silver + Vision + Adult Dental - HMO
  • Elite Gold - HMO
  • Elite Gold + Vision + Adult Dental - HMO
  • Everyday Bronze - HMO
  • Everyday Bronze + Vision + Adult Dental - HMO
  • Standard Expanded Bronze - HMO
  • Standard Expanded Bronze + Vision + Adult Dental - HMO
  • Standard Gold - HMO
  • Standard Gold + Vision + Adult Dental - HMO
  • Standard Silver - HMO
  • Standard Silver + Vision + Adult Dental - HMO
  • Choice Bronze HSA (QualChoice) - POS
  • Complete Gold - PPO
  • Complete Gold + Vision + Adult Dental - PPO
  • Complete Silver (QualChoice) - POS
  • Connected Silver - PPO
  • Connected Silver (QualChoice) - POS
  • Connected Silver (QualChoiceLife) - PPO
  • Connected Silver + Vision + Adult Dental - PPO
  • Elite Bronze - PPO
  • Elite Bronze + Vision + Adult Dental - PPO
  • Elite Gold (QualChoice) - POS
  • Elite Gold (QualChoiceLife) - PPO
  • Everyday Bronze - PPO
  • Everyday Bronze + Vision + Adult Dental - PPO
  • Everyday Gold - PPO
  • Everyday Gold + Vision + Adult Dental - PPO
  • Everyday Silver (QualChoiceLife) - PPO
  • Focused Silver - PPO
  • Focused Silver + Vision + Adult Dental - PPO
  • Standard Expanded Bronze - PPO
  • Complete Gold - EPO
  • Complete Gold + Vision + Adult Dental - EPO
  • Elite Bronze - EPO
  • Elite Bronze + Vision + Adult Dental - EPO
  • Elite Gold - EPO
  • Elite Gold + Vision + Adult Dental - EPO
  • Elite Silver - EPO
  • Elite Silver + Vision + Adult Dental - EPO
  • Everyday Bronze - EPO
  • Everyday Bronze + Vision + Adult Dental - EPO
  • Focused Silver - EPO
  • Focused Silver + Vision + Adult Dental - EPO
  • Standard Expanded Bronze - EPO
  • Standard Expanded Bronze + Vision + Adult Dental - EPO
  • Standard Gold - EPO
  • Standard Gold + Vision + Adult Dental - EPO
  • Standard Silver - EPO
  • Complete Gold - EPO
  • Complete Gold + Vision + Adult Dental - EPO
  • Complete Silver - EPO
  • Complete Silver + Vision + Adult Dental - EPO
  • Everyday Gold - EPO
  • Everyday Gold + Vision + Adult Dental - EPO
  • Focused Silver - EPO
  • Focused Silver + Vision + Adult Dental - EPO
  • Standard Gold - EPO
  • Standard Gold + Vision + Adult Dental - EPO
  • Standard Silver - EPO
  • Elite Bronze - PPO
  • Elite Bronze + Vision + Adult Dental - PPO
  • Elite Gold - PPO
  • Elite Gold + Vision + Adult Dental - PPO
  • Everyday Bronze - PPO
  • Everyday Bronze + Vision + Adult Dental - PPO
  • Everyday Gold - PPO
  • Everyday Gold + Vision + Adult Dental - PPO
  • Focused Silver - PPO
  • Focused Silver + Vision + Adult Dental - PPO
  • Standard Expanded Bronze - PPO
  • Standard Expanded Bronze + Vision + Adult Dental - PPO
  • Standard Gold - PPO
  • Standard Gold + Vision + Adult Dental - PPO
  • Standard Silver - PPO
  • Anthem Bronze Essential 6500 HSA (+ Incentives) - HMO
  • Anthem Bronze Essential 7500 Standard ($0 Virtual PCP + $0 Select Drugs + Incentives) - HMO
  • Anthem Bronze Essential 9200 (+ Incentives) - HMO
  • Anthem Bronze Essential 9200 Adult Dental/Vision (+ Incentives) - HMO
  • Anthem Bronze Essential POS 5500 ($0 Virtual PCP + $0 Select Drugs + Incentives) - POS
  • Anthem Bronze Essential POS 7500 Standard ($0 Virtual PCP + $0 Select Drugs + Incentives) - POS
  • Anthem Bronze Pathway 6900 ($0 Virtual PCP + $0 Select Drugs + Incentives) - EPO
  • Anthem Bronze Pathway 7500 Standard ($0 Virtual PCP + $0 Select Drugs + Incentives) - EPO
  • Anthem Bronze Pathway 9200 (+ Incentives) - EPO
  • Anthem Bronze Pathway HMO 7450 for HSA - HMO
  • Anthem Bronze Pathway HMO 7500 Standard ($0 Virtual PCP + $0 Select Drugs) - HMO
  • Anthem Bronze Pathway HMO 9200 ($0 Virtual PCP + $0 Select Drugs) - HMO
  • Anthem Bronze Pathway HMO 9200 Adult Dental & Vision ($0 Virtual PCP + $0 Select Drugs) - HMO
  • Anthem Bronze Pathway/Lean 5000 (3 Free PCP Visits + $0 Select Drugs + Incentives) - HMO
  • Anthem Bronze Pathway/Lean HSA (+ Incentives) - HMO
  • Anthem Bronze Pathway/Lean Standard ($0 Virtual PCP + $0 Select Drugs + Incentives) - HMO
  • Anthem Bronze Priority/Lean 5000 (3 Free PCP Visits + $0 Select Drugs + Incentives) - HMO
  • Anthem Bronze Priority/Lean HSA (+ Incentives) - HMO
  • Anthem Bronze Priority/Lean Standard ($0 Virtual PCP + $0 Select Drugs + Incentives) - HMO
  • Anthem Catastrophic Pathway 9200 (+ Incentives) - EPO
  • Bronze Complete $0 Tier-1 PCP, $0 Antidote 24/7 Virtual PCP/Urg/Chronic Care, $0 Core Rx - HMO
  • Bronze Complete+Dental $0 Tier-1 PCP, $0 Antidote 24/7 Virtual PCP/Urg/Chronic Care, $0 Core Rx - HMO
  • Bronze Elite $0 Tier-1 PCP, $0 Antidote 24/7 Virtual PCP/Urg/Chronic Care/Referred Labs, $0 Advanced Rx - HMO
  • Bronze Elite+Dental $0 Tier-1 PCP, $0 Antidote 24/7 Virtual PCP/Urg/Chronic Care/Referred Labs, $0 Advanced Rx - HMO
  • Bronze Standard - HMO
  • Catastrophic Standard - HMO
  • Gold Complete $0 Tier-1 PCP, $0 Antidote 24/7 Virtual PCP/Urg/Chronic Care, $0 Core Rx - HMO
  • Gold Complete+Dental $0 Tier-1 PCP, $0 Antidote 24/7 Virtual PCP/Urg/Chronic Care, $0 Core Rx - HMO
  • Gold Elite $0 Tier-1 PCP, $0 Antidote 24/7 Virtual PCP/Urg/Chronic Care/Referred Labs, $0 Advanced Rx - HMO
  • Gold Elite+Dental $0 Tier-1 PCP, $0 Antidote 24/7 Virtual PCP/Urg/Chronic Care/Referred Labs, $0 Advanced Rx - HMO
  • Gold Standard - HMO
  • Silver Complete $0 Tier-1 PCP, $0 Antidote 24/7 Virtual PCP/Urg/Chronic Care, $0 Core Rx - HMO
  • Silver Complete+Dental $0 Tier-1 PCP, $0 Antidote 24/7 Virtual PCP/Urg/Chronic Care, $0 Core Rx - HMO
  • Silver Elite $0 Tier-1 PCP, $0 Antidote 24/7 Virtual PCP/Urg/Chronic Care/Referred Labs, $0 Advanced Rx - HMO
  • Silver Elite+Dental $0 Tier-1 PCP, $0 Antidote 24/7 Virtual PCP/Urg/Chronic Care/Referred Labs, $0 Advanced Rx - HMO
  • Silver Standard - HMO
  • Bronze Complete $0 Tier-1 PCP, $0 Antidote 24/7 Virtual PCP/Urg/Chronic Care, $0 Core Rx - HMO
  • Bronze Complete+Dental $0 Tier-1 PCP, $0 Antidote 24/7 Virtual PCP/Urg/Chronic Care, $0 Core Rx - HMO
  • Bronze Elite $0 Tier-1 PCP, $0 Antidote 24/7 Virtual PCP/Urg/Chronic Care/Referred Labs, $0 Advanced Rx - HMO
  • Bronze Elite+Dental $0 Tier-1 PCP, $0 Antidote 24/7 Virtual PCP/Urg/Chronic Care/Referred Labs, $0 Advanced Rx - HMO
  • Bronze Standard - HMO
  • Catastrophic Standard - HMO
  • Gold Complete $0 Tier-1 PCP, $0 Antidote 24/7 Virtual PCP/Urg/Chronic Care, $0 Core Rx - HMO
  • Gold Complete+Dental $0 Tier-1 PCP, $0 Antidote 24/7 Virtual PCP/Urg/Chronic Care, $0 Core Rx - HMO
  • Gold Elite $0 Tier-1 PCP, $0 Antidote 24/7 Virtual PCP/Urg/Chronic Care/Referred Labs, $0 Advanced Rx - HMO
  • Gold Elite+Dental $0 Tier-1 PCP, $0 Antidote 24/7 Virtual PCP/Urg/Chronic Care/Referred Labs, $0 Advanced Rx - HMO
  • Gold Standard - HMO
  • Silver Complete $0 Tier-1 PCP, $0 Antidote 24/7 Virtual PCP/Urg/Chronic Care, $0 Core Rx - HMO
  • Silver Complete+Dental $0 Tier-1 PCP, $0 Antidote 24/7 Virtual PCP/Urg/Chronic Care, $0 Core Rx - HMO
  • Silver Elite $0 Tier-1 PCP, $0 Antidote 24/7 Virtual PCP/Urg/Chronic Care/Referred Labs, $0 Advanced Rx - HMO
  • Silver Elite+Dental $0 Tier-1 PCP, $0 Antidote 24/7 Virtual PCP/Urg/Chronic Care/Referred Labs, $0 Advanced Rx - HMO
  • Silver Standard - HMO
  • BEST Life Superior Dental Plan - PPO
  • BEST Essential Basic Dental Plan - PPO
  • BEST Life Essentail Basic Dental Plan - PPO
  • BEST Life Essentail Value Dental Plan - PPO
  • BEST Life Essental Value Dental Plan - PPO
  • BEST Life Essential Basic Dental - PPO
  • BEST Life Essential Basic Dental Plan - PPO
  • BEST Life Essential Basic Dental - PPO
  • BEST Life Essential Basic Dental Plan - PPO
  • BEST Life Essential Vakue Dental Plan - PPO
  • BEST Life Essential Value Dental Plan - PPO
  • BEST Life Essential Value Dental - PPO
  • BEST Life Essential Value Dental Plan - PPO
  • BEST Life Preferred Dental Plan - PPO
  • BEST Life Preferred Dental - PPO
  • BEST Life Preferred Dental Plan - PPO
  • BEST Life Preferred Dental plan - PPO
  • BEST Life Superior Dental - PPO
  • BEST Life Superior Dental Plan - PPO
  • BEST Life Superior Dental Plan - PPO
  • BlueCare Dental 4 Kids? 1A - PPO
  • BlueCare Dental 4 Kids? 1B - PPO
  • BlueCare Dental? 1A - PPO
  • BlueCare Dental? 1B - PPO
  • BlueCare Dental? 1C - PPO
  • BlueCare Dental? 1D - PPO
  • BlueCare Dental 4 Kids? 1A - PPO
  • BlueCare Dental 4 Kids? 1B - PPO
  • BlueCare Dental? 1A - PPO
  • BlueCare Dental? 1B - PPO
  • BlueCare Dental? 1C - PPO
  • BlueCare Dental? 1D - PPO
  • BlueCare Dental 4 Kids? 1A - PPO
  • BlueCare Dental 4 Kids? 1B - PPO
  • BlueCare Dental? 1A - PPO
  • BlueCare Dental? 1B - PPO
  • BlueCare Dental? 1C - PPO
  • BlueCare Dental? 1D - PPO
  • Blue Advantage Bronze HMO? 204 - HMO
  • Blue Advantage Bronze HMO? 301 - HMO
  • Blue Advantage Bronze HMO? Standard - HMO
  • Blue Advantage Gold HMO? 206 - HMO
  • Blue Advantage Gold HMO? 603 - HMO
  • Blue Advantage Gold HMO? Standard - HMO
  • Blue Advantage Plus Bronze? 303 - POS
  • Blue Advantage Plus Bronze? 305 - POS
  • Blue Advantage Plus Bronze? Standard - POS
  • Blue Advantage Plus Gold? 203 - POS
  • Blue Advantage Plus Gold? 803 - POS
  • Blue Advantage Plus Gold? Standard - POS
  • Blue Advantage Plus Silver? 202 - POS
  • Blue Advantage Plus Silver? 605 - POS
  • Blue Advantage Plus Silver? Standard - POS
  • Blue Advantage Security HMO? 200 - HMO
  • Blue Advantage Silver HMO? 205 - HMO
  • Blue Advantage Silver HMO? 801 - HMO
  • Blue Advantage Silver HMO? Standard - HMO
  • BlueCare Dental 1D - PPO
  • Connect Bronze 5500 Indiv Med Deductible - HMO
  • Connect Bronze 6000 Indiv Med Deductible - HMO
  • Connect Bronze 6500 Indiv Med Deductible Enhanced Diabetes Care - HMO
  • Connect Bronze 8500 Indiv Med Deductible - HMO
  • Connect Bronze CMS Standard - HMO
  • Connect Bronze DFW 6500 Indiv Med Deductible Enhanced Diabetes Care - HMO
  • Connect Gold 1000 Indiv Med Deductible - HMO
  • Connect Gold 2500 Indiv Med Deductible Enhanced Diabetes Care - HMO
  • Connect Gold 3250 Indiv Med Deductible - HMO
  • Connect Gold 3500 Indiv Med Deductible - HMO
  • Connect Gold CMS Standard - HMO
  • Connect Silver 3000 Indiv Med Deductible - HMO
  • Connect Silver 4000 Indiv Med Deductible - HMO
  • Connect Silver CMS Standard - HMO
  • Delta Dental Individual and Family DPO Basic Plan for Families - PPO
  • Delta Dental Individual and Family DPO Preferred Plan for Families - PPO
  • Delta Dental Individual and Family DPO Preventive Plan for Families - PPO
  • BlueDental Copayment Q - PPO
  • BlueDental Copayment QF - PPO
  • Guardian Basics for Families and Individuals - PPO
  • Guardian Choice for Families and Individuals - PPO
  • Guardian Essentials for Families and Individuals - PPO
  • Guardian Preventive Plus for Families and Individuals - PPO
  • Managed Care for Families and Individuals - HMO
  • Humana Dental Smart Choice - PPO
  • Humana Dental Smart Choice - High - PPO
  • Humana Dental Smart Choice - Lite - PPO
  • Humana Dental Smart Choice - Low - PPO
  • Humana Dental Smart Choice Basic - PPO
  • Humana Dental Smart Choice- Lite - PPO
  • Gold 1 - HMO
  • Gold 1 with Adult Vision Services - HMO
  • Gold 12 - HMO
  • Gold 8 - HMO
  • Silver 1 - HMO
  • Silver 1 with Adult Vision Services - HMO
  • Silver 12 with First 4 Primary Care Visits Free - HMO
  • Silver 8 - HMO
  • Paramount Dental Essential Plus Plan - EPO
  • Paramount Dental Preventive Family Plan - EPO
  • Paramount Dental Total Care Plan - EPO
  • HRI Essential Plus Plan - HMO
  • HRI Essential Plus Plan - PPO
  • HRI Preventive Family Plan - HMO
  • HRI Preventive Family Plan - PPO
  • HRI Total Care Plan - HMO
  • HRI Total Care Plan - PPO
  • Alabama Preferred Plan - PPO
  • Alabama Preferred Plan (Pediatric Only) - PPO
  • Alabama Preferred Plus Plan - PPO
  • Alabama Preferred Plus Plan (Pediatric Only) - PPO
  • Alabama Wellness Essentials Plan - PPO
  • Florida Preferred Plan - PPO
  • Florida Preferred Plan (Pediatric Only) - PPO
  • Florida Preferred Plus Plan - PPO
  • Florida Preferred Plus Plan (Pediatric Only) - PPO
  • Florida Wellness Essentials Plan - PPO
  • High PPO Dental Plan - PPO
  • High PPO Dental Plan (Pediatric Only) - PPO
  • Kansas Preferred Plan - PPO
  • Kansas Preferred Plan (Pediatric Only) - PPO
  • Kansas Wellness Essentials Plan - PPO
  • Low PPO Dental Plan - PPO
  • Low PPO Dental Plan (Pediatric Only) - PPO
  • Mississippi Preferred Plan - PPO
  • Mississippi Preferred Plan (Pediatric Only) - PPO
  • Mississippi Wellness Essentials Plan - PPO
  • TruAssure Basic Adult or Child Dental Plan - PPO
  • TruAssure Preferred Adult or Child Dental Plan - PPO
  • TruAssure Preventive Dental Plan - PPO
  • UHC Bronze Copay Focus $0 Indiv Med Ded ($0 Virtual Urgent Care) - HMO
  • UHC Bronze Standard - HMO
  • UHC Bronze Value ($0 Virtual Urgent Care, $3 Tier 2 Rx) - HMO
  • UHC Gold Advantage ($0 Virtual Urgent Care, $3 Tier 2 Rx) - HMO
  • UHC Gold Advantage+ ($0 Virtual Urgent Care, $3 Tier 2 Rx, Dental + Vision) - HMO
  • UHC Gold Standard - HMO
  • UHC Gold Standard $0 Indiv Ded ($0 Virtual Urgent Care) - HMO
  • UHC Silver Advantage ($0 Virtual Urgent Care, $3 Tier 2 Rx) - HMO
  • UHC Silver Advantage+ ($0 Virtual Urgent Care, $3 Tier 2 Rx, Dental + Vision) - HMO
  • UHC Silver Standard - HMO
  • UHC Silver Value ($0 Virtual Urgent Care, $3 Tier 2 Rx) - HMO
  • Smile Now Arizona - No Waiting Period PPO - PPO
  • Smile Now Illinois - No Waiting Period PPO - PPO
  • Smile Now Michigan - No Waiting Period PPO - PPO
  • Smile Now Ohio - No Waiting Period PPO - PPO
  • Smile Now Tennessee - No Waiting Period PPO - PPO
  • Smile Now Texas- No Waiting Period Plan - PPO
  • Smile Now Utah - No Waiting Period PPO - PPO
  • Wellpoint Essential Bronze 4000 HSA ($0 Virtual PCP + $0 Select Drugs + Incentives) - HMO
  • Wellpoint Essential Bronze 6000 ($0 Virtual PCP + $0 Select Drugs + Incentives) - HMO
  • Wellpoint Essential Bronze 6000 Adult Dental/Vision ($0 Virtual PCP+$0 Select Drugs) - HMO
  • Wellpoint Essential Bronze 7500 Standard ($0 Virtual PCP + $0 Select Drugs + Incentives) - HMO
  • Wellpoint Essential Bronze POS 4500 ($0 Virtual PCP + $0 Select Drugs + Incentives) - POS
  • Wellpoint Essential Bronze POS 5500 ($0 Virtual PCP + $0 Select Drugs + Incentives) - POS
  • Wellpoint Essential Bronze POS 7500 Standard ($0 Virtual PCP + $0 Select Drugs + Incentives) - POS
  • Wellpoint Essential Catastrophic 9200 ($0 Virtual PCP + $0 Select Drugs + Incentives) - HMO
  • Wellpoint Essential Gold 1500 ($0 Virtual PCP + $0 Select Drugs + Incentives) - HMO
  • Wellpoint Essential Gold 1500 Standard ($0 Virtual PCP + $0 Select Drugs + Incentives) - HMO
  • Wellpoint Essential Gold 800 ($0 Virtual PCP + $0 Select Drugs + Incentives) - HMO
  • Wellpoint Essential Gold POS 1000 ($0 Virtual PCP + $0 Select Drugs + Incentives) - POS
  • Wellpoint Essential Gold POS 1500 Standard ($0 Virtual PCP + $0 Select Drugs + Incentives) - POS
  • Wellpoint Essential Gold POS 700 ($0 Virtual PCP + $0 Select Drugs + Incentives) - POS
  • Wellpoint Essential Silver 1850 ($0 Virtual PCP + $0 Select Drugs + Incentives) - HMO
  • Wellpoint Essential Silver 3500 ($0 Virtual PCP + $0 Select Drugs + Incentives) - HMO
  • Wellpoint Essential Silver 3500 Adult Dental/Vision ($0 Virtual PCP + $0 Select Drugs + Incentives) - HMO
  • Wellpoint Essential Silver 5000 Standard ($0 Virtual PCP + $0 Select Drugs + Incentives) - HMO
  • Wellpoint Essential Silver POS 2500 ($0 Virtual PCP + $0 Select Drugs + Incentives) - POS
  • Wellpoint Essential Silver POS 4000 ($0 Virtual PCP + $0 Select Drugs + Incentives) - POS

*Please verify directly with this provider to make sure your insurance plan is currently accepted.

Medicare Participation & PECOS Enrollment Status

Roderick Kim is registered with Medicare and accepts claims assignment, this means the provider accepts the approved amount for the cost of rendered services as full payment. Participating providers may not charge beneficiaries more than the approved amount for their services. Please keep in mind that beneficiaries still have to pay a coinsurance or copayment amount for a visit or service.

Roderick Kim is enrolled in PECOS and is eligible to order or refer health care services for Medicare patients. The provider is eligible to order or refer: Part B Clinical Laboratory and Imaging, Durable Medical Equipment (DME), a Home Health Agency (HHA) and Power Mobility Devices.

What is PECOS?
PECOS is the online Medicare enrollment management system or Provider, Enrollment, Chain and Ownership System. The PECOS system is a database of providers who have registered with CMS as providers or suppliers. PECOS is the primary source of information about verified Medicare professionals. Providers that want to participate in this program need to enroll in PECOS with their NPI number to avoid denied claims.

  • Is the provider registered in PECOS? Yes

  • PECOS PAC ID: 5698081347

    What is the PECOS Associate Control ID?
    A PAC ID is a unique 10-digit number assigned to an individual or organization healthcare provider in PECOS. The PAC ID is used to link together all the provider information, like tax identification numbers and organizational names. A PAC ID can be connected to multiple Enrollment IDs if an individual or organization has enrolled in PECOS more than once.

  • PECOS Enrollment ID: I20170805000004

    What is the Provider Enrollment ID?
    The Enrollment ID is a unique alphanumeric 15-digit code assigned to each new provider's PECOS enrollment application. The Enrollment ID is used to link together all the provider enrollment information like enrollment type, state, provider specialty, and reassignment of benefits.

  • Accepts Medicare Assignment? Yes

    What does it mean "accepts medicare assignment"?
    When a provider accepts Medicare assignment, the provider agrees to be paid directly by Medicare and to accept the payment amount approved by Medicare. Additionally, the provider agrees to not bill patients for more than the Medicare deductible and coinsurance amounts.
    A provider who doesn't accept assignment may charge you up to 15% over the Medicare-approved amount. This is known as the limiting charge. You may have to pay this amount, or it may be covered by another insurer.

  • Eligible to Order or Refer Part B Clinical Laboratory and Imaging: Yes

  • Eligible to Order or Refer Durable Medical Equipment (DMEPOS): Yes

  • Eligible to Order or Refer a Home Health Agency (HHA): Yes

  • Eligible to Order or Refer Power Mobility Devices: Yes

Find Provider Hospital Affiliations - Privileges

Doctors and physicians must apply for hospital privileges to treat patients at hospitals. Find out if your doctor has privileges to practice at your preferred hospital by using the hospital affiliation information below based on recent medical claims.

Hospital affiliation is identified through self-reporting data, inpatient, outpatient, physician and ancillary service claims linked by the medical claims NPI number and place of service code. Additionally, to further determine provider hospital affiliation the clinician must have provided services to at least three patients on three different dates in the last 12 months. Roderick Kim is affiliated with the following medical facilities:

Hospital Name Address Phone Hospital Type Overall Rating
JPS HEALTH NETWORK1500 S MAIN ST
FORT WORTH, TX 76104
(817) 921-3431Acute Care Hospitals

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NPI Validation Check Digit Calculation


The following table explains the step by step NPI number validation process using the ISO standard Luhn algorithm.

Start with the original NPI number, the last digit is the check digit and is not used in the calculation.
1689954562
Step 1: Double the value of the alternate digits, beginning with the rightmost digit.
261691858512
Step 2: Add all the doubled and unaffected individual digits from step 1 plus the constant number 24.
2 + 6 + 1 + 6 + 9 + 1 + 8 + 5 + 8 + 5 + 1 + 2 + 24 = 78
Step 3: Subtract the total obtained in step 2 from the next higher number ending in zero, the result is the check digit.
80 - 78 = 22

The NPI number 1689954562 is valid because the calculated check digit 2 using the Luhn validation algorithm matches the last digit of the original NPI number.

Frequently Asked Questions

The NPI number assigned to this healthcare provider is 1689954562, enumerated as an "individual" on August 23, 2011.

The provider is located at 1500 S MAIN ST DEPT OF FORT WORTH, TX 76104 and the phone number is (817) 702-6936.

Oral & Maxillofacial Surgery with taxonomy code 204E00000X.

The provider might be accepting Accepts: Aetna CVS Health, Ambetter from Arizona Complete. Please consult your insurance carrier or call the provider to verify.

Roderick Kim is affiliated with: JPS HEALTH NETWORK.