NPIMap

Individual provider Active NPI

John S Park, M.D.

  • Colon & Rectal Surgery Physician
  • Allentown, PA
National Provider Identifier
1083690200
Registry record updated Mar 18, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Colon & Rectal Surgery PhysicianTaxonomy code 208C00000X
License
MD071167L Issued in PA
Practice address
1255 S Cedar Crest Blvd
Suite 3900
Allentown, PA 18103-6256
Phone
(610) 402-1095
Fax
(610) 435-5003
NPI assigned
Dec 20, 2005
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 18, 2015

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Colon & Rectal Surgery Physician 208C00000X MD071167L PA Primary

Addresses

Primary practice location

1255 S Cedar Crest Blvd
Suite 3900
Allentown, PA 18103-6256

Mailing address

1255 S Cedar Crest Blvd
Suite 3900
Allentown, PA 18103-6256
Phone (610) 402-1095

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in PA
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
I20081125000368 PA Practitioner - Colorectal Surgery (Proctology) 7719075522 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Colorectal Surgery (Proctology)
Education
Other, 1995
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Colon Rectal Surgery Associates PCGroup PAC ID 7618954421, 5 clinicians
Lehigh Valley Physician GroupGroup PAC ID 3072425123, 2,512 clinicians

Practice addresses (Care Compare)

1255 S Cedar Crest Blvd
Suite 3900
Allentown, PA 18103-6250
Phone (484) 788-0840

401 N 17TH St
105 LV Specialty Care Physicians Practice
Allentown, PA 18104-5049
Phone (610) 969-4470

Hospital & facility affiliations

  • Lehigh Valley Health Network Home health agency, Saint Clair, PA, CCN 397214
  • Lehigh Valley Hospital Hospital, Allentown, PA, CCN 390133
  • Lehigh Valley Hospital - Hazleton Hospital, Hazleton, PA, CCN 390185

Procedures performed for Medicare patients

ProcedureNumber of procedures
Colonoscopy131
Removal of tissue1-10
Removal of skin lesions1-10

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Lehigh Valley Physician Group CurrentSince Nov 3, 2008 Accepting new patients
Integrated Medical Group, P.C. CurrentSince Sep 16, 2024 Accepting new patients
Integrated Medical Group P C CurrentSince Sep 16, 2024 Accepting new patients
Lehigh Valley Physician Group CurrentSince Dec 18, 2017 Accepting new patients
Colon Rectal Surgery Associates PC Colon & Rectal Surgery CurrentSince Nov 3, 2008 Accepting new patients
Lehigh Valley Hospital Past Accepting new patients

Locations

1210 S Cedar Crest Blvd
Ste 3300
Allentown, PA 18103
Phone (610) 402-8506

1255 S Cedar Crest Blvd
Ste 3900
Allentown, PA 18103
Phone (484) 788-0840

3147 College Heights Blvd
Allentown, PA 18104
Phone (610) 841-2432

401 N 17th St
Ste 105
Allentown, PA 18104
Phone (610) 432-2013

2045 Westgate Dr
Ste 305
Bethlehem, PA 18017
Phone (610) 867-0832

82 Tunnel Rd
Pottsville, PA 17901
Phone (570) 622-5455

48 Tunnel Rd
Ste 104
Pottsville, PA 17901
Phone (570) 622-5555

Interoperability endpoints

  • Direct secure messaging: jpark@colonrectalsurgery.medentdirect.com

Organizations & group practices 7

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 7

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": "1135036800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1426636800000",
    "number": "1083690200",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1255 S CEDAR CREST BLVD",
            "address_2": "SUITE 3900",
            "city": "ALLENTOWN",
            "state": "PA",
            "postal_code": "181036256",
            "telephone_number": "610-402-1095",
            "fax_number": "610-435-5003"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1255 S CEDAR CREST BLVD",
            "address_2": "SUITE 3900",
            "city": "ALLENTOWN",
            "state": "PA",
            "postal_code": "181036256",
            "telephone_number": "610-402-1095",
            "fax_number": "610-435-5003"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PARK",
        "first_name": "JOHN",
        "middle_name": "S",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-12-20",
        "last_updated": "2015-03-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208C00000X",
            "taxonomy_group": "",
            "desc": "Colon & Rectal Surgery",
            "state": "PA",
            "license": "MD071167L",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Allentown, PA

Sources for this page

Verify at the official NPI Registry.