Jennifer M Park, MD

Primary specialty

Psychiatry PhysicianTaxonomy code 2084P0800X

License

0101248210 Issued in VA

Practice address

131 Old Road to 9 Acre Cor Ste 620
Concord, MA 01742-4191

Phone

(703) 403-4204

Fax

(571) 446-4015

NPI assigned

Oct 28, 2005

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

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.

Opted out of Medicare

Yes, effective Jan 2, 2016 through Jan 2, 2028

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

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.

• NSPG Billing LLC

  • Urology Physician
  • Newburyport, MA
  • NPI 1144981721
  NPD (past)

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

{
    "created_epoch": "1130457600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1695686400000",
    "number": "1063402147",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "80 ROLLINGWOOD LN",
            "city": "CONCORD",
            "state": "MA",
            "postal_code": "017424302",
            "telephone_number": "703-403-4204",
            "fax_number": "571-446-4015"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "131 OLD ROAD TO 9 ACRE COR STE 620",
            "city": "CONCORD",
            "state": "MA",
            "postal_code": "017424191",
            "telephone_number": "703-403-4204",
            "fax_number": "571-446-4015"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1355 Beverly Rd",
            "address_2": "Suite 225",
            "address_purpose": "LOCATION",
            "city": "Mc Lean",
            "state": "VA",
            "postal_code": "221013651",
            "country_code": "US",
            "telephone_number": "703-403-4204",
            "fax_number": "571-297-6277",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "PARK",
        "first_name": "JENNIFER",
        "middle_name": "M",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2005-10-28",
        "last_updated": "2023-09-26",
        "certification_date": "2023-09-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2084P0800X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "MA",
            "license": "210049",
            "primary": false
        },
        {
            "code": "2084P0800X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "VA",
            "license": "0101248210",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Maggie Violet Painter, LCSW, M. ED.
• Lauren Kionne Palmaccio, LMHC
• Marvi Panhwar, LCSW
• Hytho H Pantazelos, MD
• Elizabeth Anne Parachini, LMHC
• Laurie Ann Parks, M. ED. M.S.
• Keshav Parthasarathy, M.D.
• Wyatt Tucker Pasco
• Janice Patel, MD
• Rina M Patel, PMHNP-BC

• Psychiatry Physician in Concord, MA
• Providers in Concord, MA by specialty
• Psychiatry Physician in Massachusetts

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 26, 2023; 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; Opt Out Affidavits.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.