NPIMap

Individual provider Active NPI

Kevin L Park, MD

  • Family Medicine Physician
  • Bryan, OH
National Provider Identifier
1063441491
Registry record updated Mar 29, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
35-055915 Issued in OH
Practice address
442 W High St Ste 3
Bryan, OH 43506-1681
Phone
(419) 636-4517
Fax
(419) 636-6438
NPI assigned
Jun 30, 2006
Last updated
Mar 29, 2023By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 29, 2023

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 35-055915 OH Primary

Addresses

Primary practice location

442 W High St Ste 3
Bryan, OH 43506-1681

Mailing address

11109 Parkview Plaza Dr # 117
Fort Wayne, IN 46845-1701

Other identifiers 2

IdentifierTypeStateIssuer
080059933OtherOHRAILROAD
0878386MedicaidOH

Electronic endpoints 3

TypeEndpointUseAffiliation
FHIR URL https://epicprod-mobile.parkview.com/FHIR/api/FHIR/DSTU2/
Direct Messaging Address kpark9305@Direct.Parkviewexchange.com
FHIR URL https://epicprod-mobile.parkview.com/FHIR/api/FHIR/R4/

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20100624000931 OH Practitioner - Family Practice 8123159886 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Toledo Medical College, 1986
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Midwest Community Health Associates, Inc.Group PAC ID 0941114250, 100 clinicians

Practice addresses (Care Compare)

442 W High St
Bryan, OH 43506-1681
Phone (260) 266-8210

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
87.74 of 100Reported as group
Quality
87.56
Promoting interoperability
100
Improvement activities
40
Cost
71.58

Procedures performed for Medicare patients

ProcedureNumber of procedures
Removal of skin lesions1-10

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
35-055915OHMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Robinair Leasing Co., LLC Past Accepting new patients
Lima Memorial Joint Operating Company Past Accepting new patients
Williams County Office of Auditor Past Accepting new patients

Interoperability endpoints

  • Direct secure messaging: kpark9305@direct.parkviewexchange.com

Ownership & related parties

All facility ownership & control disclosures 1

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
Evergreen Healthcare CenterMontpelier, OH, CCN 365495 Skilled nursing facility Operational/Managerial Control
Adp of the SNF		 Oct 1, 2024
Oct 4, 2024

Owned or controlled facilities with NPI records 1

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 10

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": "1151625600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1680048000000",
    "number": "1063441491",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11109 PARKVIEW PLAZA DR # 117",
            "city": "FORT WAYNE",
            "state": "IN",
            "postal_code": "468451701"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "442 W HIGH ST STE 3",
            "city": "BRYAN",
            "state": "OH",
            "postal_code": "435061681",
            "telephone_number": "419-636-4517",
            "fax_number": "419-636-6438"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PARK",
        "first_name": "KEVIN",
        "middle_name": "L",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-06-30",
        "last_updated": "2023-03-29",
        "certification_date": "2023-03-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "OH",
            "license": "35-055915",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD",
            "identifier": "080059933",
            "state": "OH"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0878386",
            "state": "OH"
        }
    ],
    "endpoints": [
        {
            "endpointType": "FHIR",
            "endpointTypeDescription": "FHIR URL",
            "endpoint": "https://epicprod-mobile.parkview.com/FHIR/api/FHIR/DSTU2/",
            "affiliation": "N",
            "address_1": "442 W High St Ste 3",
            "city": "Bryan",
            "state": "OH",
            "country_code": "US",
            "postal_code": "435061681",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "kpark9305@Direct.Parkviewexchange.com",
            "affiliation": "N",
            "address_1": "442 W High St Ste 3",
            "city": "Bryan",
            "state": "OH",
            "country_code": "US",
            "postal_code": "435061681",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "FHIR",
            "endpointTypeDescription": "FHIR URL",
            "endpoint": "https://epicprod-mobile.parkview.com/FHIR/api/FHIR/R4/",
            "affiliation": "N",
            "address_1": "442 W High St Ste 3",
            "city": "Bryan",
            "state": "OH",
            "country_code": "US",
            "postal_code": "435061681",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Bryan, OH

Sources for this page

Verify at the official NPI Registry.