Active NPI 1871623678 Individual Practitioner Male Practitioner

Dr. Shane Christopher Kim , MD

Plastic Surgery • Portland, OR

✓ Accepts Medicare Assignment Telehealth Available

Professional Overview & Biography Verified Profile Summary

Dr. Shane Kim, MD is a certified Plastic Surgery practicing in Portland, OR. With approximately 24 years of clinical experience since completing medical education in 2002, Dr. Kim delivers high-quality medical care to the local community at 1130 NW 22ND AVE STE 420.

Dr. Kim maintains professional affiliations with Legacy Salmon Creek Hospital, Legacy Clinics Llc and accepts Medicare assignment . Telehealth and virtual consultation options are available for eligible patients.

Frequently performed procedures and clinical services include established patient outpatient office visit, new patient outpatient office visit, release of wrist ligament using an endoscope. Full Medicare procedure pricing transparency rates and service volume details are listed on this profile.

Practice Location & Contact Primary Location

Practice Address

1130 Nw 22nd Ave Ste 420

Portland, OR 972102995

Telephone 5034134992

Fax 5034133699

Medicare Profile & Education

Medical School

Other

Graduation Year

2002

Medicare Assignment

✓ Accepts Assignment

Telehealth Flag

Telehealth Services Available

Specialty Benchmarks & Practice Insights

Comparative analytics for Plastic Surgery in Portland, OR

Senior Veteran Specialist (>20 Yrs)

Practitioner Clinical Experience

24 Yrs +1.3 yrs vs City Avg

City Avg: 22.7 Yrs

State Avg: 21.9 Yrs

Regional Practice Density

38 Specialists

Practicing in Portland, OR (66 Statewide)

Telehealth Adoption Rate

18.4% Regional Adoption

✓ Offers Virtual Consultations

Medicare Pricing Discount

62.1% Avg Savings

Under CMS Medicare Fee Schedule vs Standard Submitted Charges

Clinical Seniority & Experience Comparison

Dr. Kim (24 Years) 24 Yrs

Portland Specialty Average (22.7 Years) 22.7 Yrs

Performed Procedures & Service Volume

Top Medicare Part B procedures performed by this practitioner

CMS Official Data (2024)

Reporting Year:

HCPCS Code & Description	Services	Patients	Submitted Charge	Medicare Allowed
99213 Established patient office or other outpatient visit, typically 15 minutes	46	42	$241.00	$91.87
99204 New patient office or other outpatient visit with moderate level of medical decision making, if using time, 45 minutes or more	20	20	$445.00	$164.19
29848 Release of wrist ligament using an endoscope	18	16	$1470.39	$561.27

HCPCS Code & Description	Services	Patients	Submitted Charge	Medicare Allowed
99204 New patient office or other outpatient visit with moderate level of medical decision making, if using time, 45 minutes or more	69	69	$450.48	$166.49
99213 Established patient office or other outpatient visit, typically 15 minutes	41	36	$233.68	$87.92
29848 Release of wrist ligament using an endoscope	26	24	$1563.48	$567.14
J3301 Injection, triamcinolone acetonide, not otherwise specified, 10 mg	25	21	$7.40	$1.01
26055 Incision of tendon covering	14	11	$1278.43	$210.21
20550 Injection into tendon or ligament	14	11	$156.00	$53.91

HCPCS Code & Description	Services	Patients	Submitted Charge	Medicare Allowed
99213 Established patient office or other outpatient visit, typically 15 minutes	57	47	$211.00	$90.89
99204 New patient office or other outpatient visit with moderate level of medical decision making, if using time, 45 minutes or more	52	52	$463.00	$169.18
J3301 Injection, triamcinolone acetonide, not otherwise specified, 10 mg	24	16	$7.40	$1.12
20550 Injection into tendon or ligament	16	11	$136.50	$48.10
99203 New patient office or other outpatient visit with low level of medical decision making, if using time, 30 minutes or more	14	14	$303.00	$115.67
99214 Established patient office or other outpatient visit with moderate level of decision making, if using time, 30 minutes or more	11	11	$306.00	$133.25

HCPCS Code & Description	Services	Patients	Submitted Charge	Medicare Allowed
99204 New patient office or other outpatient visit with moderate level of medical decision making, if using time, 45 minutes or more	82	82	$463.00	$174.14
99213 Established patient office or other outpatient visit, typically 15 minutes	68	62	$211.00	$95.38
J3301 Injection, triamcinolone acetonide, not otherwise specified, 10 mg	62	41	$7.40	$1.25
20550 Injection into tendon or ligament	44	32	$156.00	$51.05
99203 New patient office or other outpatient visit with low level of medical decision making, if using time, 30 minutes or more	25	25	$303.00	$116.72
29848 Release of wrist ligament using an endoscope	21	20	$1573.93	$571.48
99214 Established patient office or other outpatient visit with moderate level of decision making, if using time, 30 minutes or more	19	18	$306.00	$124.37
26055 Incision of tendon covering	17	13	$831.00	$225.84

HCPCS Code & Description	Services	Patients	Submitted Charge	Medicare Allowed
99213 Established patient office or other outpatient visit, typically 15 minutes	76	57	$210.39	$77.70
99203 New patient office or other outpatient visit with low level of medical decision making, if using time, 30 minutes or more	67	67	$303.39	$112.77
J3301 Injection, triamcinolone acetonide, not otherwise specified, 10 mg	28	23	$7.40	$1.50
20550 Injection into tendon or ligament	19	16	$157.74	$55.93
29848 Release of wrist ligament using an endoscope	17	16	$1512.91	$554.83

HCPCS Code & Description	Services	Patients	Submitted Charge	Medicare Allowed
99203 New patient office or other outpatient visit with low level of medical decision making, if using time, 30 minutes or more	98	98	$305.00	$112.10
99213 Established patient office or other outpatient visit, typically 15 minutes	91	63	$208.24	$77.08
J3301 Injection, triamcinolone acetonide, not otherwise specified, 10 mg	68	42	$7.40	$1.59
20605 Aspiration and/or injection of medium joint or joint capsule	31	20	$150.97	$46.81
20550 Injection into tendon or ligament	31	22	$151.00	$50.77
29848 Release of wrist ligament using an endoscope	23	21	$1536.00	$559.58

HCPCS Code & Description	Services	Patients	Submitted Charge	Medicare Allowed
99213 Established patient office or other outpatient visit, typically 15 minutes	93	71	$206.00	$72.33
99203 New patient office or other outpatient visit with low level of medical decision making, if using time, 30 minutes or more	85	85	$305.00	$107.65
J3301 Injection, triamcinolone acetonide, not otherwise specified, 10 mg	49	34	$7.32	$1.78
20550 Injection into tendon or ligament	28	21	$151.00	$48.57
29848 Release of wrist ligament using an endoscope	15	14	$1569.87	$564.31
20605 Aspiration and/or injection of medium joint or joint capsule	15	12	$143.80	$48.48

HCPCS Code & Description	Services	Patients	Submitted Charge	Medicare Allowed
99213 Established patient office or other outpatient visit, typically 15 minutes	69	45	$205.59	$74.39
99203 New patient office or other outpatient visit with low level of medical decision making, if using time, 30 minutes or more	48	48	$305.00	$108.09
J3301 Injection, triamcinolone acetonide, not otherwise specified, 10 mg	47	17	$6.38	$1.82
20550 Injection into tendon or ligament	17	12	$154.71	$45.76

Medical Specialties & State Licenses

Plastic Surgery Primary Specialty

NUCC Taxonomy Code: 208200000X

State License OR MD29423

A plastic surgeon deals with the repair, reconstruction or replacement of physical defects of form or function involving the skin, musculoskeletal system, craniomaxillofacial structures, hand, extremities, breast and trunk and external genitalia or cosmetic enhancement of these areas of the body. Cosmetic surgery is an essential component of plastic surgery. The plastic surgeon uses cosmetic surgical principles to both improve overall appearance and to optimize the outcome of reconstructive procedures. The surgeon uses aesthetic surgical principles not only to improve undesirable qualities of normal structures but in all reconstructive procedures as well.

Hospital & Practice Group Affiliations

Legacy Clinics Llc

2222 Nw Lovejoy St, Portland, OR 972105100

Legacy Clinics Llc

2801 N Gantenbein Ave, Portland, OR 972271623

Phone: 5034131122

Legacy Clinics Llc

1015 Nw22nd Ave, Portland, OR 972103025

Phone: 5034136376

Legacy Clinics Llc

1015 Nw 22nd Ave, Portland, OR 972103025

Phone: 5034137711

Legacy Salmon Creek Hospital

2211 Ne 139th St, Vancouver, WA 986862742

Phone: 3604871000

Legacy Clinics Llc

1130 Nw 22nd Ave, Portland, OR 972102969

Phone: 5034138988

Practice Associates & Co-Workers

Healthcare professionals and specialists practicing at this location or sharing practice phone/fax

11 Associated Practitioners

Caroline Gao

Student in an Organized Health Care Education/Training Program

NPI 1093655417

Summer Tran

Student in an Organized Health Care Education/Training Program

NPI 1578394755

Amanda Marsiglia , PA-C

Physician Assistant - Surgical

NPI 1649790221

Physician Assistant (Certified)

Dr. Cassandra Tomczak , DPM

Podiatrist - Foot & Ankle Surgery

NPI 1689991804

Doctor of Podiatric Medicine

Dr. Justin Tidwell , DPM

Podiatrist - Foot & Ankle Surgery

NPI 1710908892

Doctor of Podiatric Medicine

Louise Fricker

Student in an Organized Health Care Education/Training Program

NPI 1750220323

Career & Practice History Timeline

Chronological log of verified NPI updates, location relocations, credentials, and registry changes

6 Historical Events

✅

NPI Profile Active July 15, 2013

NPI status registered as active in NPPES database

📍

Updated Practice Location July 15, 2013

Registered at 1130 NW 22ND AVE STE 420, PORTLAND, OR 972102995 (Tel: 5034134992)

📍

Updated Business Mailing Address July 15, 2013

Registered at 1130 NW 22ND AVE STE 420, PORTLAND, OR 972102995 (Tel: 5034134992)

👤

Provider Name / Credentials Updated July 15, 2013

Recorded as SHANE KIM, MD

🎓

Medical Taxonomy / Specialty Registered (Primary Specialty) July 15, 2013

Plastic Surgery (License #MD29423 in OR)

🟢

Initial NPI Registration & Enumeration March 07, 2007

First registered as active Individual Practitioner in NPPES Database.

Patient & Community Reviews

Verified patient ratings, medical care experiences, and facility photos

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NPI Administrative Meta

NPI Number: 1871623678

Entity Type:

Individual Provider Physician, Nurse Practitioner, or Solo Healthcare Professional (Type 1 NPI)

Enumeration Date: March 07, 2007

Last Update: July 15, 2013

Sole Proprietor: Yes

Update or Correct Profile

Mailing Address

1130 Nw 22nd Ave Ste 420

Portland, OR 972102995

Phone: 5034134992

Public Domain Record This profile contains public domain information published by CMS and NPPES under the Freedom of Information Act (FOIA).

⚠️ Medical Disclaimer

This directory listing is for informational purposes only and does not constitute medical advice, diagnosis, or physician endorsement. If you are experiencing a medical emergency, please call 911 immediately.