Benjamin Park, M.D.

Primary specialty

Aerospace Medicine PhysicianTaxonomy code 2083A0100X

License

01062522A Issued in IN

Practice address

4881 Sugar Maple Dr
Wpafb, OH 45433-5529

Phone

(937) 255-4809

NPI assigned

Aug 5, 2006

Sex

Male

Sole proprietor

No

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

Enrolled in IN

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.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

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

{
    "created_epoch": "1154736000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1749427200000",
    "number": "1144239740",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4881 SUGAR MAPLE DR",
            "city": "WPAFB",
            "state": "OH",
            "postal_code": "454335529",
            "telephone_number": "937-255-4809"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4881 SUGAR MAPLE DR",
            "city": "WPAFB",
            "state": "OH",
            "postal_code": "454335529",
            "telephone_number": "937-255-4809"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PARK",
        "first_name": "BENJAMIN",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-08-05",
        "last_updated": "2025-06-09",
        "certification_date": "2025-06-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "IN",
            "license": "01062522A",
            "primary": false
        },
        {
            "code": "2083A0100X",
            "taxonomy_group": "",
            "desc": "Preventive Medicine, Aerospace Medicine",
            "state": "IN",
            "license": "01062522A",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Melissa Marie Odenweller
• Meghan Olsen, MD
• Alexander Vaun Padalino, DDS
• Brian Elliot Patel, R. PH.
• Sneh L Patwa, M.D.
• Rachelle Paul-Kagiri, M.D.
• Jamie Penny
• Susan M Perry, CRNA

• Aerospace Medicine Physician in Wpafb, OH
• Providers in Wpafb, OH by specialty
• Aerospace Medicine Physician in Ohio

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 9, 2025; 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.