NPIMap

Individual provider Active NPI

Samuel Joon Park, M.D.

  • Internal Medicine Physician
  • Mineola, NY
National Provider Identifier
1053607952
Registry record updated Nov 12, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
28444 Issued in WV
Practice address
160 1St St Unit 551
Mineola, NY 11501-5025
Phone
(516) 619-8098
NPI assigned
Jun 20, 2011
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Nov 12, 2021

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

Specialties & licenses 6

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X 01081067A IN
Internal Medicine Physician 207R00000X 28444 WV Primary
Pediatrics Physician 208000000X 285562 NY
Pediatrics Physician 208000000X CDRH.0057133 CO
Internal Medicine Physician 207R00000X CDRH.0057133 CO
Internal Medicine Physician 207R00000X 285562 NY

Addresses

Primary practice location

160 1St St Unit 551
Mineola, NY 11501-5025

Mailing address

160 1St St Unit 551
Mineola, NY 11501-5025
Phone (516) 619-8098

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WV, PA, NY, OH, IL, ID, KS7 enrollments
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 7

Enrollment IDStateProvider typePAC IDDetails
I20180904000641 WV Practitioner - Internal Medicine 2860775475 Reassigns benefits to 1 organization
I20210323002554 PA Practitioner - Internal Medicine 2860775475
I20220504002645 NY Practitioner - Internal MedicinePractitioner - Psychiatry 2860775475 Reassigns benefits to 2 organizations
I20250829002520 OH Practitioner - Internal Medicine 2860775475 Reassigns benefits to 2 organizations
I20260128002196 IL Practitioner - Internal Medicine 2860775475 Reassigns benefits to 1 organization
I20260130001137 ID Practitioner - Internal Medicine 2860775475 Reassigns benefits to 1 organization
I20260511000265 KS Practitioner - Internal Medicine 2860775475 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Internal Medicine
Education
Other, 2011
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Sound Physicians of IdahoGroup PAC ID 4688705346, 47 clinicians
Sound Physicians of Illinois LLCGroup PAC ID 1557533734, 193 clinicians

Practice addresses (Care Compare)

1 Akron General Ave
Akron, OH 44307-2432
Phone (330) 344-6000

415 6TH St
Lewiston, ID 83501-2431
Phone (208) 743-2511

812 N Logan Ave
Danville, IL 61832-3752
Phone (217) 443-5000

Hospital & facility affiliations

  • St Joseph Regional Medical Center Hospital, Lewiston, ID, CCN 130003
  • Osf Sacred Heart Medical Center Hospital, Danville, IL, CCN 140093
  • Tri-State Memorial Hospital Hospital, Clarkston, WA, CCN 501332
  • Clearwater Valley Hospital & Clinics Hospital, Orofino, ID, CCN 131320
  • St Mary'S Hospital Hospital, Cottonwood, ID, CCN 131321

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
285562NYMDLicensed Practical Nurse
28444WVMDInternal Medicine Physician
CDRH.0057133COMDPediatrics Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Sound Physicians of Idaho Internal Medicine CurrentSince Dec 17, 2025 Accepting new patients
Sound Physicians of Illinois, LLC Internal Medicine CurrentSince Jan 31, 2026 Accepting new patients
Physician Affiliate Group of New York PC CurrentSince Mar 1, 2024 Accepting new patients
Hospitalist Medicine Physicians of Ohio-Columbus II Professional Corp Internal Medicine CurrentSince Jun 20, 2025 Accepting new patients
Hospitalist Medicine Physicians of Ohio, Professional Corporation Internal Medicine CurrentSince Feb 8, 2026 Accepting new patients

Locations

415 6th St
Lewiston, ID 83501
Phone (208) 750-7445

1512 12th Ave Rd
Nampa, ID 83686
Phone (208) 463-5000

1044 N Francisco Ave
Chicago, IL 60622
Phone (773) 292-8227

812 N Logan Ave
Danville, IL 61832
Phone (217) 443-5000

2601 Ocean Pkwy
Rm 3N17
Brooklyn, NY 11235
Phone (718) 616-4554

2601 Ocean Pkwy
Brooklyn, NY 11235
Phone (718) 616-5354

506 Malcolm X Blvd
New York, NY 10037
Phone (212) 939-1000

1 Akron General Ave
Akron, OH 44307
Phone (330) 344-5760

2420 Lake Ave
Ashtabula, OH 44004
Phone (216) 986-2919

272 Hospital Rd
Chillicothe, OH 45601
Phone (740) 779-4275

181 Taylor Ave
Columbus, OH 43203
Phone (614) 257-2358

100 Dawn Ln
Waverly, OH 45690
Phone (740) 947-2186

120 Brentwood Commons Way
Ste 510
Brentwood, TN 37027
Phone (253) 682-6040

Networks

  • Healthfirst Medicare Network H3359
  • Healthfirst Medicare Network H1722
  • Healthfirst Medicare Network H5989
  • Healthfirst Medicare Network H9678

Interoperability endpoints

  • Direct secure messaging: spark2032666@nychhc.direct-ci.com

Organizations & group practices 8

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 16

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

View all 16

NPI Registry JSON

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

{
    "created_epoch": "1308528000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1636675200000",
    "number": "1053607952",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "160 1ST ST UNIT 551",
            "city": "MINEOLA",
            "state": "NY",
            "postal_code": "115015025",
            "telephone_number": "516-619-8098"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "160 1ST ST UNIT 551",
            "city": "MINEOLA",
            "state": "NY",
            "postal_code": "115015025",
            "telephone_number": "516-619-8098"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PARK",
        "first_name": "SAMUEL",
        "middle_name": "JOON",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2011-06-20",
        "last_updated": "2021-11-12",
        "certification_date": "2021-11-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "IN",
            "license": "01081067A",
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "WV",
            "license": "28444",
            "primary": true
        },
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "NY",
            "license": "285562",
            "primary": false
        },
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "CO",
            "license": "CDRH.0057133",
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "CO",
            "license": "CDRH.0057133",
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "NY",
            "license": "285562",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Mineola, NY

Sources for this page

Verify at the official NPI Registry.