Individual provider Active NPI

Ji Hye Park, FNP

  • Family Nurse Practitioner
  • Roseville, CA
National Provider Identifier
1063477016
Registry record updated Dec 13, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
15502 Issued in CA
Practice address
1 Medical Plaza Dr
Roseville, CA 95661-3037
Phone
(916) 781-5000
Fax
(916) 781-5055
NPI assigned
Apr 20, 2006
Last updated
Dec 13, 2019By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 13, 2019

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X 15502 CA Primary

Addresses

Primary practice location

1 Medical Plaza Dr
Roseville, CA 95661-3037

Mailing address

1 Medical Plaza Dr
Roseville, CA 95661-3037
Phone (323) 580-1382

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20061229000447 CA Practitioner - Nurse Practitioner 9931109766

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Sutter Valley Hospitals CurrentSince Jun 1, 2021 Accepting new patients
Sutter Valley Hospitals Current Accepting new patients
Sutter Valley Hospitals CurrentSince Jun 1, 2021 Accepting new patients

Locations

1 Medical Plaza Dr
Roseville, CA 95661
Phone (916) 781-1000

1625 Stockton Blvd
Ste 112
Sacramento, CA 95816
Phone (916) 887-4001

Organizations & group practices 3

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.

NPI Registry JSON

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

{
    "created_epoch": "1145491200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1576195200000",
    "number": "1063477016",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1 MEDICAL PLAZA DR",
            "city": "ROSEVILLE",
            "state": "CA",
            "postal_code": "956613037",
            "telephone_number": "323-580-1382"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1 MEDICAL PLAZA DR",
            "city": "ROSEVILLE",
            "state": "CA",
            "postal_code": "956613037",
            "telephone_number": "916-781-5000",
            "fax_number": "916-781-5055"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PARK",
        "first_name": "JI HYE",
        "credential": "FNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-04-20",
        "last_updated": "2019-12-13",
        "certification_date": "2019-12-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "CA",
            "license": "15502",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Roseville, CA

Sources for this page

Verify at the official NPI Registry.