JENNA KIM
NPI 1730990417
Physician Assistant in Patchogue, NY

Q: What is Jenna Kim's NPI number?

The NPI number for Jenna Kim is 1730990417. It was assigned to this individual provider in the NPPES registry on January 14, 2025.

Q: What is Jenna Kim's specialty?

The primary specialty registered for this NPI is Physician Assistant with taxonomy code 363A00000X.

Q: When was this NPI record last updated?

The NPPES record for Jenna Kim was last updated on March 12, 2025. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 17 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.

Active since January 14, 2025PECOS Enrolled

101 HOSPITAL RD, PATCHOGUE, NY 11772(631) 654-7100 Get Directions Write a Review

NPPES record last updated: March 12, 2025. Verified against the NPPES registry weekly; last sync: August 09, 2026.

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About Jenna Kim NPPES

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

JENNA KIM (NPI 1730990417) is an individual physician assistant in Patchogue, New York and active in the NPI registry since January 2025. She is enrolled in Medicare PECOS.

NPPES Registry Identity

NPI1730990417

Entity TypeIndividualFemale

Primary Taxonomy363A00000X

Provider Legal NameJENNA KIM

Location Address101 HOSPITAL RDPatchogue, NY 11772-4870

Mailing Address2037 Dauntless DrGlenview, IL 60026-6811

Phone(631) 654-7100

Sole ProprietorYes

Enumeration DateJanuary 14, 2025

Last NPPES UpdateMarch 12, 2025

NPPES CertifiedMarch 12, 2025

✔ NPI 1730990417 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyPhysician AssistantPhysician Assistants & Advanced Practice Nursing Providers

Taxonomy Code363A00000X

Definition

A physician assistant is a person who has successfully completed an accredited education program for physician assistant, is licensed by the state and is practicing within the scope of that license. Physician assistants are formally trained to perform many of the routine, time-consuming tasks a physician can do. In some states, they may prescribe medications. They take medical histories, perform physical exams, order lab tests and x-rays, and give inoculations. Most states require that they work under the supervision of a physician.

101 HOSPITAL RD, Patchogue, NY 11772

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Medicare Participation & PECOS CMS

Medicare enrollment, assignment, and ordering and referring status from the CMS PECOS system.

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

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

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.

Physician Visit Costs CMS claims · ZIP area

Typical Medicare office-visit costs in the 11772 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

$105.06 typical visit price

range $67.40 – $203.53

Typical copayment $26.26 (range $16.85 – $50.88)

Most-billed visit code 99203

Established Patient

$83.44 typical visit price

range $21.66 – $164.45

Typical copayment $20.86 (range $5.41 – $41.11)

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.

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.

VAISHALI MEHTA MD

Internal Medicine (Critical Care Medicine)