DR. SAMUEL C. KIM MD
NPI 1720379100
Ophthalmology - Retina Specialist in Upland, CA

Q: What is Samuel Kim's NPI number?

The NPI number for Samuel Kim is 1720379100. It was assigned to this individual provider in the NPPES registry on April 20, 2011.

Q: What is Samuel Kim's specialty?

The primary specialty registered for this NPI is Ophthalmology, specializing in Retina Specialist, with taxonomy code 207WX0107X.

Q: When was this NPI record last updated?

The NPPES record for Samuel Kim was last updated on June 24, 2020. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 6 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.

Active since April 20, 2011PECOS EnrolledAccepts Medicare Assignment

81.53/100

CMS Quality Rating

555 N 13TH AVE, UPLAND, CA 91786(909) 982-8846(909) 949-3967 Get Directions Write a Review

NPPES record last updated: June 24, 2020. Verified against the NPPES registry weekly; last sync: August 02, 2026.

Record update history: Jun 24, 2020, Mar 17, 2018, Jul 24, 2017 and 1 more (4 updates tracked since 2017).

On this page

About Dr. Samuel C. Kim Md NPPES

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

DR. SAMUEL C. KIM MD (NPI 1720379100) is an individual retina specialist in Upland, California, licensed in California (A123812) and active in the NPI registry since April 2011. He is enrolled in Medicare PECOS, maintains 2 additional practice locations, and is a graduate of Loma Linda University School Of Medicine (2011).

NPPES Registry Identity

NPI1720379100

Entity TypeIndividualMale

Primary Taxonomy207WX0107X

Provider Legal NameDR. SAMUEL C. KIMCredential: MD

Location Address555 N 13TH AVEUpland, CA 91786-4904

Mailing Address555 N 13th AveUpland, CA 91786-4904 · (909) 982-8846 · Fax (909) 949-3967

Phone(909) 982-8846

Fax(909) 949-3967

Sole ProprietorYes

Medical School CMSLoma Linda University School Of MedicineGraduated 2011

Enumeration DateApril 20, 2011

Last NPPES UpdateJune 24, 20204 updates tracked since enumeration

NPPES CertifiedJune 24, 2020

✔ NPI 1720379100 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 3

★ Primary SpecialtyOphthalmology · Retina SpecialistAllopathic & Osteopathic Physicians

Taxonomy Code207WX0107X

License✔ Licensed in CA · A123812

Definition

An ophthalmologist who specializes in the diagnosis and treatment of vitreoretinal diseases.

Also ListedOphthalmologyTaxonomy 207W00000X · License MD042959 (DC), 0101257811 (VA)

Also ListedStudent in an Organized Health Care Education/Training ProgramTaxonomy 390200000X

555 N 13TH AVE, Upland, CA 91786

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Secondary Practice Locations 2

Location 17501 Greenway Center Dr # 300Greenbelt, MD 20770-3514 · Phone (301) 474-4679 · Fax (301) 474-7182

Location 211370 Anderson St Ste 1800Loma Linda, CA 92354-3450 · Phone (909) 558-2154 · Fax (909) 558-2180

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

Dr. Samuel C. Kim Md 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 ID5597076554

PECOS Enrollment IDI20170623000846

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 11

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

Injection, faricimab-svoa, 0.1 mg J2777

Faricimab-svoa is a medication given through an injection into the eye to treat certain eye conditions. The 0.1 mg dosage helps control disease progression, improving vision and eye health. The procedure is done by a healthcare professional.

25,985 services78 patients

Established patient complete exam of visual system 92014

An established patient complete exam of the visual system involves a thorough check of your eyes and vision. It assesses eye health, checks for diseases, and measures your ability to see clearly at different distances. It's a routine, non-invasive procedure.

1,459 services600 patients

Imaging of retina 92134

Imaging of the retina is a non-invasive procedure that captures detailed images of your eye's interior. This helps detect conditions like macular degeneration or retinal detachment. It's painless and takes only a few minutes.

1,286 services487 patients

Injection of drug into eye 67028

An injection into the eye is a procedure where a medication is delivered directly into your eye to treat various conditions. A local anesthetic is applied to numb the eye, ensuring minimal discomfort. The drug helps manage diseases like macular degeneration or diabetic retinopathy.

994 services246 patients

Injection, aflibercept, 1 mg J0178

Aflibercept injection is a treatment for certain eye conditions that affect vision. It works by blocking abnormal blood vessel growth and leakage in the eye, which can cause vision loss. The medication is administered directly into the eye by a healthcare professional.

629 services76 patients

Photography of the retina 92250

Photography of the retina, also known as retinal imaging, is a non-invasive procedure that captures images of the back of your eye. This helps doctors identify and monitor conditions like glaucoma, macular degeneration, or diabetic retinopathy. It's painless and quick, often part of a routine eye exam.

373 services236 patients

Physician Visit Costs CMS claims · ZIP area

Typical Medicare office-visit costs in the 91786 ZIP code area, from fee-for-service claims. These are area statistics, not this provider’s prices; actual charges vary by service and coverage.

New Patient

$136.04 typical visit price

range $59.60 – $179.42

Typical copayment $34.01 (range $14.90 – $44.85)

Most-billed visit code 99204

Established Patient

$74.08 typical visit price

range $19.37 – $146.42

Typical copayment $18.52 (range $4.84 – $36.60)

Most-billed visit code 99213

Amounts reflect what Medicare beneficiaries in this ZIP area are typically charged for office visits. Patients with other coverage should check their individual plans.

Medicare Quality Performance CMS QPP · MIPS

Performance in the CMS Quality Payment Program: the MIPS final score across four weighted categories, and the individual quality measures reported to Medicare.

81.53/100

MIPS Final ScoreMerit-based Incentive Payment System · CMS Quality Payment Program

Scored as part of a group practice

Quality

97.99

Promoting Interoperability

Improvement Activities

Cost

58.49

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Other Providers at the Same Location NPPES 17

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

DR. SIDDHARTH BHARGAVA MD

Ophthalmology