John Moonkeun Park, MD

Primary specialty

Vascular Surgery PhysicianTaxonomy code 2086S0129X

License

26509 Issued in NE

Practice address

17404 Burke St Ste 102
Omaha, NE 68118-2242

Phone

(531) 466-4260

NPI assigned

Oct 27, 2011

Sex

Male

Sole proprietor

No

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

Specialties & licenses 4

Addresses

Other identifiers 5

Medicare fee-for-service enrollment

Enrolled in NE, IA2 enrollments

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 2

Specialty

Vascular Surgery

Education

University of Nebraska College of Medicine, 2005

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Vascular and Interventional Radiology of SiouxlandGroup PAC ID 7113330663, 24 clinicians

Sage Medical Prof LLCGroup PAC ID 4385992619, 15 clinicians

Foot and Ankle Center of Nebraska PCGroup PAC ID 2567409063, 10 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• CHI Health Bergan Mercy Hospital, Omaha, NE, CCN 280060
• CHI Health Immanuel Hospital, Omaha, NE, CCN 280081
• Shenandoah Medical Center Hospital, Shenandoah, IA, CCN 161366
• Montgomery County Memorial Hospital Hospital, Red Oak, IA, CCN 161363
• CHI Health Mercy Council Bluffs Hospital, Council Bluffs, IA, CCN 160028

Procedures performed for Medicare patients

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

Networks

• CO HMO D-SNP
• devoted network organization-a4751131-f16f-4e82-8f2b-b08e66379a7a
• IA HMO C-SNP
• IA HMO
• CO HMO
• devoted network organization-2b183dd2-4e80-4977-80a6-4fdf0df4361d

Interoperability endpoints

• Direct secure messaging: john.park@direct.nmhs.org

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.

• Foot and Ankle Center of Nebraska, P.C.

  • Podiatrist
  • Omaha, NE
  • NPI 1730149246

  IA

  Medicare reassignment Care Compare group NPD
• Sage Medical Prof LLC

  • Vascular Surgery Physician
  • Dakota Dunes, SD
  • NPI 1588156657

  NE

  Medicare reassignment Care Compare group NPD
• Vascular & Interventional Radiology of Siouxland

  • Vascular Surgery Physician
  • Dakota Dunes, SD
  • NPI 1225636129

  IA, NE

  Medicare reassignment Care Compare group
• Healogics Specialty Physicians of Nebraska, LLC

  • Undersea and Hyperbaric Medicine (Preventive Medicine) Physician
  • Norfolk, NE
  • NPI 1831575133

  Surgery

  Medicare reassignment NPD
• Physicians Clinic Inc

  • Family Medicine Physician
  • Omaha, NE
  • NPI 1821049156

  IA, Surgery

  Medicare reassignment NPD
• United Vascular of Omaha LLC

  • Ambulatory Surgical Clinic/Center
  • Omaha, NE
  • NPI 1326551623
  Medicare reassignment NPD
• Healogics Specialty Physicians of Iowa, LLC

  • Undersea and Hyperbaric Medicine (Preventive Medicine) Physician
  • Council Bluffs, IA
  • NPI 1184041113
  Medicare reassignment NPD
• Foot and Ankle Center of Nebraska, P.C.

  • Durable Medical Equipment & Medical Supplies
  • Papillion, NE
  • NPI 1740790963
  NPD
• Nebraska Methodist Hospital

  • General Acute Care Hospital
  • Omaha, NE
  • NPI 1427147883
  NPD
• Foot and Ankle Center of Nebraska, P.C.

  • Durable Medical Equipment & Medical Supplies
  • Council Bluffs, IA
  • NPI 1740743368
  NPD
• Advanced Vascular and Vein Center LLC

  • Vascular Surgery Physician
  • Omaha, NE
  • NPI 1679767610
  NPD (past)

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

• Alegent Health Bergan Mercy Health System

  • Psychiatric Hospital Unit
  • Omaha, NE
  • NPI 1396969499
  Care Compare affiliation
• Alegent Health Bergan Mercy Health System

  • General Acute Care Hospital
  • Omaha, NE
  • NPI 1508941097
  Care Compare affiliation
• Alegent Health Immanuel Medical Center

  • General Acute Care Hospital
  • Omaha, NE
  • NPI 1912085184
  Care Compare affiliation
• Alegent Health Bergan Mercy Health System

  • General Acute Care Hospital
  • Council Bluffs, IA
  • NPI 1265517759
  Care Compare affiliation
• Montgomery County Memorial Hospital

  • Critical Access Hospital
  • Red Oak, IA
  • NPI 1376539338
  Care Compare affiliation
• Shenandoah Medical Center

  • Critical Access Hospital
  • Shenandoah, IA
  • NPI 1184621096
  Care Compare affiliation

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

{
    "created_epoch": "1319673600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1758585600000",
    "number": "1023394665",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "17404 BURKE ST STE 102",
            "city": "OMAHA",
            "state": "NE",
            "postal_code": "681182242",
            "telephone_number": "351-466-4260"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "17404 BURKE ST STE 102",
            "city": "OMAHA",
            "state": "NE",
            "postal_code": "681182242",
            "telephone_number": "531-466-4260"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PARK",
        "first_name": "JOHN",
        "middle_name": "MOONKEUN",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2011-10-27",
        "last_updated": "2025-09-23",
        "certification_date": "2025-09-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2086S0129X",
            "taxonomy_group": "",
            "desc": "Surgery, Vascular Surgery",
            "state": "OH",
            "license": "35.095909",
            "primary": false
        },
        {
            "code": "208600000X",
            "taxonomy_group": "",
            "desc": "Surgery",
            "state": "OH",
            "license": "35.095909",
            "primary": false
        },
        {
            "code": "2086S0129X",
            "taxonomy_group": "",
            "desc": "Surgery, Vascular Surgery",
            "state": "NE",
            "license": "26509",
            "primary": true
        },
        {
            "code": "2086S0129X",
            "taxonomy_group": "",
            "desc": "Surgery, Vascular Surgery",
            "state": "IA",
            "license": "40563",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "10025724800",
            "state": "NE"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "10026135100",
            "state": "NE"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1023394665",
            "state": "IA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "47068731713",
            "state": "NE"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "10026454700",
            "state": "NE"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Shannon C Parish
• Lisa L Parisien, LIMHP, LADC
• Saara Gal Parisin
• Andrea Park, M.D.
• Dong Joo Park, MD
• Kwangwon Park, MD, PHD
• Sangjin Park
• Timothy Park, MD
• Gail S. Parker Cahill, MSW
• Parker Neuroscience, LLC

• Vascular Surgery Physician in Omaha, NE
• Providers in Omaha, NE by specialty
• Vascular Surgery Physician in Nebraska

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 23, 2025; 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.