Individual provider Active NPI

Sung Woong Park

  • Internal Medicine Physician
  • Clermont, FL
National Provider Identifier
1033670914
Registry record updated Sep 19, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
ME163770 Issued in FL
Practice address
1900 Don Wickham Dr
Clermont, FL 34711-1979
Phone
(525) 368-8303
Fax
(352) 236-8841
NPI assigned
Mar 25, 2019
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 19, 2023

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X ME163770 FL Primary
Internal Medicine Physician 207R00000X 2022-00792 NC

Addresses

Primary practice location

1900 Don Wickham Dr
Clermont, FL 34711-1979

Mailing address

1900 Don Wickham Dr
Clermont, FL 34711-1979
Phone (352) 536-8830

Other practice location 1

2700 Wayne Memorial Dr
Goldsboro, NC 27534-9494
Phone (919) 587-4394

Electronic endpoints 3

TypeEndpointUseAffiliation
Direct Messaging Address spark170257@direct.UNC.nchie.net Direct
Other URL providerenrollment@orlandohealth.com
Other URL providerenrollment@orlandohealth.com

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NC, FL2 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

Enrollment IDStateProvider typePAC IDDetails
I20220822000897 NC Practitioner - Internal Medicine 2961738802 Reassigns benefits to 1 organization
I20230906003895 FL Practitioner - Internal Medicine 2961738802 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Internal Medicine
Education
Other, 2022
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Orlando Health Medical Group IncGroup PAC ID 9537059084, 2,171 clinicians

Practice addresses (Care Compare)

1900 Don Wickham Dr
Clermont, FL 34711-1979
Phone (352) 536-8840

Hospital & facility affiliations

  • Orlando Health South Lake Hospital Hospital, Clermont, FL, CCN 100051
  • Uf Health Leesburg Hospital Hospital, Leesburg, FL, CCN 100084
  • Orlando Health Hospital, Orlando, FL, CCN 100006

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
ME163770FLMDInternal Medicine Physician
2022-00792NCMDInternal Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Unc Physicians Network LLC Current Accepting new patients
Orlando Health Medical Group Inc CurrentSince Aug 1, 2023 Accepting new patients
Unc Physicians Network LLC Internal Medicine CurrentSince Jul 14, 2022 Accepting new patients
Orlando Health Medical Group Inc Internal Medicine CurrentSince Aug 1, 2023 Accepting new patients

Locations

1900 Don Wickham Dr
Clermont, FL 34711
Phone (352) 536-8761

32 W Gore St
Orlando, FL 32806
Phone (321) 841-3820

940 Martin Luther King Jr Blvd
Chapel Hill, NC 27514
Phone (919) 942-5123

2700 Wayne Memorial Dr
Goldsboro, NC 27534
Phone (919) 731-6060

5221 Paramount Pkwy
Ste 220
Morrisville, NC 27560
Phone (984) 215-4110

Networks

  • Freedom Health HMO Network
  • Optimum HealthCare HMO Network

Organizations & group practices 4

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.

Hospital & facility affiliations 5

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

NPI Registry JSON

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

{
    "created_epoch": "1553472000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1695081600000",
    "number": "1033670914",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1900 DON WICKHAM DR",
            "city": "CLERMONT",
            "state": "FL",
            "postal_code": "347111979",
            "telephone_number": "352-536-8830",
            "fax_number": "352-536-8841"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1900 DON WICKHAM DR",
            "city": "CLERMONT",
            "state": "FL",
            "postal_code": "347111979",
            "telephone_number": "525-368-8303",
            "fax_number": "352-236-8841"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2700 Wayne Memorial Dr",
            "address_purpose": "LOCATION",
            "city": "Goldsboro",
            "state": "NC",
            "postal_code": "275349494",
            "country_code": "US",
            "telephone_number": "919-587-4394",
            "fax_number": "919-587-2998",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "PARK",
        "first_name": "SUNG",
        "middle_name": "WOONG",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2019-03-25",
        "last_updated": "2023-09-19",
        "certification_date": "2023-09-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "FL",
            "license": "ME163770",
            "primary": true
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "NC",
            "license": "2022-00792",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "spark170257@direct.UNC.nchie.net",
            "affiliation": "N",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "CDA/CCD/TXT",
            "address_1": "2700 Wayne Memorial Dr",
            "city": "Goldsboro",
            "state": "NC",
            "country_code": "US",
            "postal_code": "275349494",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "OTHERS",
            "endpointTypeDescription": "Other URL",
            "endpoint": "providerenrollment@orlandohealth.com",
            "affiliation": "N",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "1900 Don Wickham Dr",
            "city": "Clermont",
            "state": "FL",
            "country_code": "US",
            "postal_code": "347111979",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "OTHERS",
            "endpointTypeDescription": "Other URL",
            "endpoint": "providerenrollment@orlandohealth.com",
            "affiliation": "N",
            "address_1": "1900 Don Wickham Dr",
            "city": "Clermont",
            "state": "FL",
            "country_code": "US",
            "postal_code": "347111979",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Clermont, FL

Sources for this page

Verify at the official NPI Registry.