Parkpoom Phatharacharukul, M.D.

Primary specialty

Gastroenterology PhysicianTaxonomy code 207RG0100X

License

72751 Issued in MN

Practice address

6500 Excelsior Blvd
St Louis Park, MN 55426-4702

Phone

(952) 993-3240

NPI assigned

Apr 3, 2014

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 3

Addresses

Medicare fee-for-service enrollment

Enrolled in MN

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

Specialty

Gastroenterology

Education

Other, 2011

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Group practices

Park Nicollet ClinicGroup PAC ID 7911819438, 1,778 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Park Nicollet Methodist Hospital Hospital, Saint Louis Park, MN, CCN 240053

Merit-based Incentive Payment System (MIPS)

Final score

84.78 of 100Reported as group

Quality

78.77

Promoting interoperability

100

Improvement activities

40

Cost

70.49

Procedures performed for Medicare patients

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

Practice roles

Locations

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.

• Park Nicollet Clinic

  • Family Medicine Physician
  • St Louis Park, MN
  • NPI 1780621904
  Medicare reassignment Care Compare group NPD
• Park Nicollet Clinic

  • Family Medicine Physician
  • St Louis Park, MN
  • NPI 1063897593
  NPD
• Park Nicollet Clinic

  • Family Medicine Physician
  • Brooklyn Park, MN
  • NPI 1447668678
  NPD

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

• Park Nicollet Methodist Hospital

  • General Acute Care Hospital
  • Maple Grove, MN
  • NPI 1174980692
  Care Compare affiliation
• Park Nicollet Methodist Hospital

  • General Acute Care Hospital
  • St Louis Park, MN
  • NPI 1194113217
  Care Compare affiliation
• Park Nicollet Methodist Hospital

  • General Acute Care Hospital
  • St Louis Park, MN
  • NPI 1245615772
  Care Compare affiliation
• Park Nicollet Methodist Hospital

  • Mental Illness Community Based Residential Treatment Facility
  • St Louis Park, MN
  • NPI 1578717336

  Hospital

  Care Compare affiliation
• Park Nicollet Methodist Hospital

  • General Acute Care Hospital
  • St Louis Park, MN
  • NPI 1649220724
  Care Compare affiliation
• Park Nicollet Methodist Hospital

  • General Acute Care Hospital
  • St Louis Park, MN
  • NPI 1942585286
  Care Compare affiliation

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

{
    "created_epoch": "1396483200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1697760000000",
    "number": "1205254547",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8170 33RD AVE S # MS 21110Q",
            "city": "BLOOMINGTON",
            "state": "MN",
            "postal_code": "554254516"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6500 EXCELSIOR BLVD",
            "city": "ST LOUIS PARK",
            "state": "MN",
            "postal_code": "554264702",
            "telephone_number": "952-993-3240"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "420 Delaware St SE",
            "address_2": "MMC 284 Phillips Wangensteen Bldg 14th Floor, Suite 100",
            "address_purpose": "LOCATION",
            "city": "Minneapolis",
            "state": "MN",
            "postal_code": "554550341",
            "country_code": "US",
            "telephone_number": "612-626-5031",
            "fax_number": "612-625-3238",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1205 S Grange Ave Ste 510",
            "address_purpose": "LOCATION",
            "city": "Sioux Falls",
            "state": "SD",
            "postal_code": "571050410",
            "country_code": "US",
            "telephone_number": "605-328-8500",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "702 Rotary Cir Ste 225",
            "address_purpose": "LOCATION",
            "city": "Indianapolis",
            "state": "IN",
            "postal_code": "462025133",
            "country_code": "US",
            "telephone_number": "317-278-4427",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "PHATHARACHARUKUL",
        "first_name": "PARKPOOM",
        "name_prefix": "Mr.",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2014-04-03",
        "last_updated": "2023-10-20",
        "certification_date": "2023-10-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207RG0100X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Gastroenterology",
            "state": "SD",
            "license": "11709",
            "primary": false
        },
        {
            "code": "207RG0100X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Gastroenterology",
            "state": "MN",
            "license": "72751",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Robert A Peterson
• Steven Peterson, NP
• Sarah E Petrich, PT
• Suzanne Marie Pflaum, PA-C
• Hailey Pham, DCM
• Dennis A Philander, MD
• Muriel Denise Philipp, CNP, MA, RN
• Becky Philipsek, PA
• Alicia C Phillips, R.D.
• Christian Phillips, M.D.

• Gastroenterology Physician in St Louis Park, MN
• Providers in St Louis Park, MN by specialty
• Gastroenterology Physician in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 20, 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.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.