DR. SAMUEL JISOO KIM DO, MA
NPI 1851617500
Anesthesiology in Seattle, WA
About Dr. Samuel Jisoo Kim Do, Ma NPPES
Official registry information on file with the National Plan and Provider Enumeration System.
DR. SAMUEL JISOO KIM DO, MA (NPI 1851617500) is an individual anesthesiology provider in Seattle, Washington, licensed in Washington (OL 60159865) and active in the NPI registry since April 2010. He is enrolled in Medicare PECOS, is affiliated with Evergreenhealth Medical Center, and is a graduate of Western University Of Health Sciences College Of Dental Med (2010).
NPPES Registry Identity
Specialties & Licenses
Medicare Participation & PECOS CMS
Medicare enrollment, assignment, billing reassignment, and ordering and referring status from CMS.
Medicare Enrollment Status
Enrolled in Medicare and accepts Medicare assignment
Dr. Samuel Jisoo Kim Do, Ma 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.
Medicare Billing Reassignment
Medicare enrollment records show Samuel Kim reassigns Medicare billing to 1 organization. The organization bills Medicare for the services this provider delivers there.
Bellevue, WA 98004
- Reassigned Medicare billing, Washington enrollment
- 94 clinicians in this Medicare group
Source: CMS Revalidation Reassignment List, October 2026 release. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.
Hospital Affiliations CMS Care Compare
Hospitals where this provider delivers care, identified from recent Medicare claims and place-of-service records.
Evergreenhealth Medical Center
Acute Care Hospitals · Kirkland, WAOther Providers at the Same Location NPPES
Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.
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 Samuel Kim's NPI number?
The NPI number for Samuel Kim is 1851617500. It was assigned to this individual provider in the NPPES registry on April 19, 2010.
Where is Samuel Kim located?
Samuel Kim practices at 815 Mercer St Univ Of Washington Gme Office, Seattle, WA 98109. The listed phone number is (206) 390-7397.
What is Samuel Kim's specialty?
The primary specialty registered for this NPI is Anesthesiology with taxonomy code 207L00000X.
Is Samuel Kim enrolled in Medicare?
Yes. Samuel Kim is registered in the Medicare PECOS system and accepts Medicare assignment, which means accepting the Medicare-approved amount as payment in full for covered services.
Which organization bills Medicare for Samuel Kim's services?
According to the CMS Revalidation Reassignment List (October 2026 release), Samuel Kim reassigns Medicare benefits to Matrix Anesthesia, Ps (Bellevue, WA). 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 Samuel Kim's services. Reassignment records can lag staffing changes; confirm current arrangements with the organization.
Is Samuel Kim affiliated with any hospitals?
According to CMS data, Samuel Kim is affiliated with Evergreenhealth Medical Center.
When was this NPI record last updated?
The NPPES record for Samuel Kim was last updated on May 5, 2014. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 12 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.
# Dr. Samuel Jisoo Kim, DO, MA · NPI 1851617500
Anesthesiology physician in Seattle, Washington. Individual provider, active in the CMS NPPES registry since April 19, 2010.
## Identity
- **NPI:** 1851617500 (Entity type: Individual)
- **Enumerated:** April 19, 2010
- **Primary specialty:** Anesthesiology · taxonomy 207L00000X
- **State license:** OL 60159865 (Washington)
- **Sole proprietor:** No
## Practice location
- **Address:** 815 MERCER ST, UNIV OF WASHINGTON GME OFFICE, Seattle, WA 98109-4714
- **Phone:** (206) 390-7397
## Medicare
- **Medicare:** Enrolled (PECOS); accepts Medicare assignment
- **Ordering & referring:** eligible for Part B labs & imaging, durable medical equipment, home health, power mobility devices
- **Bills Medicare through:** Matrix Anesthesia, Ps (NPI 1831146422, Bellevue, WA), under Medicare reassignment (form CMS-855R) · CMS Revalidation Reassignment List, October 2026 release
- **Medical school:** Western University Of Health Sciences College Of Dental Med, class of 2010
## Record status
- **NPPES last updated:** May 5, 2014
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Source: [NPI Profile](https://npiprofile.com/npi/1851617500) · Data from the CMS NPPES public registry.