Mary Kim, DMD in Chicago, IL - Medicare Dentist Provider

Mary Kim, DMD is a medicare enrolled "Dentist - General Practice" provider in Chicago, Illinois. Her current practice location is 2424 W Peterson Ave, Chicago, Illinois. You can reach out to her office (for appointments etc.) via phone at (773) 761-0300.

Mary Kim is licensed to practice in Georgia (license number DN122544) and she also participates in the medicare program. She does not accept medicare assignments directly but she may accept medicare through third-party (refer to Reassignment section below) and may also prescribe medicare part D drugs. Her NPI Number is 1184165516.

Contact Information

	Mary Kim, DMD
	2424 W Peterson Ave, Chicago, IL 60659-4100
	(773) 761-0300
	(773) 761-0300

Map and Direction

Healthcare Provider's Profile

Full Name	Mary Kim
Gender	Female
Speciality	Dentist - General Practice
Location	2424 W Peterson Ave, Chicago, Illinois
Accepts Medicare Assignments	Medicare enrolled and may accept medicare through third-party reassignment. May prescribe medicare part D drugs.

NPI Data:

NPI Number: 1184165516
Provider Enumeration Date: 03/18/2017
Last Update Date: 03/01/2022

Medicare PECOS Information:

PECOS PAC ID: 9335557271
Enrollment ID: I20220628000467

Medical Identifiers

Medical identifiers for Mary Kim such as npi, medicare ID, medicare PIN, medicaid, etc.

Identifier	Type	State	Issuer
1184165516	NPI	-	NPPES

Medical Taxonomies and Licenses

Taxonomy	Type	License (State)	Status
122300000X	Dentist	019031189 (Illinois)	Secondary
122300000X	Dentist	34965 (Texas)	Secondary
390200000X	Student In An Organized Health Care Education/training Program	(* (Not Available))	Secondary
1223G0001X	Dentist - General Practice	DN122544 (Georgia)	Primary

Medicare Reassignments

Some practitioners may not bill the customers directly but medicare billing happens through clinics / group practice / hospitals where the provider works. Medicare reassignment of benefits is a mechanism by which practitioners allow third parties to bill and receive payment for medicare services performed by them. Mary Kim allows following entities to bill medicare on her behalf.

Entity Name	Southside Medical Center, Inc.
Entity Type	Part B Supplier - Clinic/group Practice
Entity Identifiers	NPI Number: 1235123993 PECOS PAC ID: 6901700723 Enrollment ID: O20031212000357

Entity Name	Good Samaritan Health Center Of Cobb
Entity Type	Part B Supplier - Clinic/group Practice
Entity Identifiers	NPI Number: 1881923126 PECOS PAC ID: 7214970482 Enrollment ID: O20050608000595

Medicare Part D Prescriber Enrollment

Any physician or other eligible professional who prescribes Part D drugs must either enroll in the Medicare program or opt out in order to prescribe drugs to their patients with Part D prescription drug benefit plans. Mary Kim is enrolled with medicare and thus, if eligible, can prescribe medicare part D drugs to patients with medicare part D benefits.

Mailing Address and Practice Location

Mailing Address	Practice Location Address
Mary Kim, DMD 500 Prestwick Ln, Wheeling, IL 60090-6231 Ph: (847) 668-0125	Mary Kim, DMD 2424 W Peterson Ave, Chicago, IL 60659-4100 Ph: (773) 761-0300

Reviews and Comments

Dentist in Chicago, IL

Dr. Philip E Fidel, DDS Dentist Medicare: Not Enrolled in Medicare Practice Location: 3236 W Fullerton Ave, Chicago, IL 60647 Phone: 773-276-0300 Fax: 773-252-5994
Bilus D Poles, DDS Dentist Medicare: Medicare Enrolled Practice Location: 1945 W Wilson Ave, Chicago, IL 60640 Phone: 773-275-8855
Theresa Westfallen, Dentist Medicare: Not Enrolled in Medicare Practice Location: 1738 W North Ave, Chicago, IL 60622 Phone: 773-276-5566 Fax: 773-276-8780
Dr. Justine S Gasior, DDS Dentist Medicare: Not Enrolled in Medicare Practice Location: 6820 S Pulaski Rd, Chicago, IL 60629 Phone: 773-581-4627 Fax: 773-581-3155
Dr. William Kwok Kuen Wan, M.D. Dentist Medicare: Not Enrolled in Medicare Practice Location: 2262 S. Wentworth Ave, 2nd Floor, Chicago, IL 60616 Phone: 312-791-1013 Fax: 312-791-1444
Gandy S Garcia, D.D.S. Dentist Medicare: Not Enrolled in Medicare Practice Location: 3915 W 26th St, Chicago, IL 60623 Phone: 773-522-2929 Fax: 773-522-2930
Dr. Sodabeh Etminan, DMD Dentist Medicare: Medicare Enrolled Practice Location: 7131 S Jeffery Blvd Ste A, Chicago, IL 60649 Phone: 773-256-0526

Mary Kim, DMD - Medicare Dentist in Chicago, IL