Minnsun Koh Park, M.D.

Primary specialty

Cardiovascular Disease PhysicianTaxonomy code 207RC0000X

License

ME146480 Issued in FL

Practice address

3900 University Blvd S
Jacksonville, FL 32216-4331

Phone

(904) 222-6656

NPI assigned

Mar 20, 2013

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in NM

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Specialty

Cardiovascular Disease (Cardiology)

Education

Tulane University School of Medicine, 2013

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Group practices

Las Cruces Physician Practices, LLCGroup PAC ID 7618974858, 107 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Memorial Medical Center Hospital, Las Cruces, NM, CCN 320018
• Mountain View Regional Medical Center Hospital, Las Cruces, NM, CCN 320085
• Three Crosses Regional Hospital LLC Hospital, Las Cruces, NM, CCN 320091
• Sierra Vista Hospital Hospital, T Or C, NM, CCN 321300

Merit-based Incentive Payment System (MIPS)

Final score

100 of 100Reported as group

Promoting interoperability

100

Improvement activities

40

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

Networks

• TX HMO
• CO HMO
• devoted network organization-a4751131-f16f-4e82-8f2b-b08e66379a7a
• NM HMO C-SNP
• TX HMO D-SNP
• CO HMO D-SNP

Interoperability endpoints

• Direct secure messaging: minnsun.park.1@19849.direct.athenahealth.com
• Direct secure messaging: minnsunpark@ahvcpa.allscriptsdirect.net

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Las Cruces Physician Practices, LLC

  • Vascular Surgery Physician
  • Las Cruces, NM
  • NPI 1093947491
  Medicare reassignment Care Compare group NPD
• Las Cruces Physician Practices, LLC

  • Cardiovascular Disease Physician
  • Las Cruces, NM
  • NPI 1346586195
  NPD
• Las Cruces Physician Practices, LLC

  • Family Medicine Physician
  • Las Cruces, NM
  • NPI 1356390769

  Cardiovascular Disease

  NPD
• Bagnoli and Salah Partnership

  • Pulmonary Disease Physician
  • Jacksonville, FL
  • NPI 1144287335
  NPD (past)
• Sierra Vista Hospital

  • Rural Health Clinic/Center
  • Truth Or Consequences, NM
  • NPI 1689638942
  NPD (past)

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

• Las Cruces Medical Center LLC

  • General Acute Care Hospital
  • Las Cruces, NM
  • NPI 1205882503
  Care Compare affiliation
• PHC-Las Cruces Inc

  • General Acute Care Hospital
  • Las Cruces, NM
  • NPI 1700821808
  Care Compare affiliation
• Sierra Vista Hospital

  • Critical Access Hospital
  • Truth Or Consequences, NM
  • NPI 1760446009
  Care Compare affiliation
• Three Crosses Regional Hospital LLC

  • General Acute Care Hospital
  • Las Cruces, NM
  • NPI 1760020044
  Care Compare affiliation

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1363737600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1596153600000",
    "number": "1003158767",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3900 UNIVERSITY BLVD S",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322164331",
            "telephone_number": "904-222-6656"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3900 UNIVERSITY BLVD S",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322164331",
            "telephone_number": "904-222-6656"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1430 Tulane Ave",
            "address_2": "SL-37",
            "address_purpose": "LOCATION",
            "city": "New Orleans",
            "state": "LA",
            "postal_code": "701122632",
            "country_code": "US",
            "telephone_number": "504-998-6689",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "PARK",
        "first_name": "MINNSUN",
        "middle_name": "KOH",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2013-03-20",
        "last_updated": "2020-07-31",
        "certification_date": "2020-07-31",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207RC0000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Cardiovascular Disease",
            "state": "FL",
            "license": "ME146480",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Chin W. Park
• Kwang SE Park, M.D.
• Lauren Park
• Lucienne Park, DMD
• Michelle Park
• Shin Park
• Yong S Park, DMD
• John C Parke, PA-C
• Mary C Parke, LD/N
• Allison Parker, PA-C

• Cardiovascular Disease Physician in Jacksonville, FL
• Providers in Jacksonville, FL by specialty
• Cardiovascular Disease Physician in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 31, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.