Charles Keyu Park, M.D.

Primary specialty

Psychiatry PhysicianTaxonomy code 2084P0800X

License

CDRH42664 Issued in CO

Practice address

10099 Ridgegate Pkwy Ste 420
Lone Tree, CO 80124-5536

Phone

(303) 800-6463

Fax

(303) 500-6585

NPI assigned

Oct 26, 2006

Last updated

Jan 31, 2024By the provider in NPPES

Sex

Male

Sole proprietor

Yes

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 CO

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

PsychiatryAlso: Addiction Medicine

Education

New York Medical College, 2001

Medicare assignment

May accept Medicare assignment

Telehealth

Offers telehealth services

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

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

• Agami Health Services LLC

  • Psychiatry Physician
  • Lone Tree, CO
  • NPI 1194183020
  Medicare reassignment NPD
• Arahant Mental Wellness

  • Psychiatry Physician
  • Lakewood, CO
  • NPI 1699329649
  NPD (past)

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

{
    "created_epoch": "1161820800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1706659200000",
    "number": "1235214131",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10099 RIDGEGATE PKWY STE 420",
            "city": "LONE TREE",
            "state": "CO",
            "postal_code": "801245536",
            "telephone_number": "303-800-6463",
            "fax_number": "303-500-6585"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10099 RIDGEGATE PKWY STE 420",
            "city": "LONE TREE",
            "state": "CO",
            "postal_code": "801245536",
            "telephone_number": "303-800-6463",
            "fax_number": "303-500-6585"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PARK",
        "first_name": "CHARLES",
        "middle_name": "KEYU",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-10-26",
        "last_updated": "2024-01-31",
        "certification_date": "2024-01-31",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2084P0800X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "CO",
            "license": "CDRH42664",
            "primary": true
        },
        {
            "code": "2084P0802X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Addiction Psychiatry",
            "state": "CO",
            "license": "CDRH42664",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Park Meadows Anesthesia, LLC
• Park Meadows Cosmetic Surgery, PC
• Park Meadows Outpatient Surgery, LLC
• Park Meadows Vision Associates PLLC
• Park Ridge Surgery Center, LLC (Park Ridge Surgery Center)
• Hy Gia Young Park, MPH, MS, MD
• Gannon Parker, PA
• Parkridge Endodontics, PC
• Parkridge Vision Specialists, PC
• Stephanie Parks

• Psychiatry Physician in Lone Tree, CO
• Providers in Lone Tree, CO by specialty
• Psychiatry Physician in Colorado

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 31, 2024; 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.