Ken H. Park, M.D.

Primary specialty

Internal Medicine PhysicianTaxonomy code 207R00000X

License

050049 Issued in GA

Practice address

1624 Mars Hill Rd Ste B
Watkinsville, GA 30677-4813

Phone

(706) 310-1030

NPI assigned

Dec 1, 2005

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in GA

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

Internal Medicine

Education

Medical College of Georgia School of Medicine, 1998

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Group practices

Oconee Primary Care, L.L.C.Group PAC ID 4981749470, 2 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Enhabit Home Health Home health agency, Hartwell, GA, CCN 117069
• Piedmont Home Health Home health agency, Athens, GA, CCN 117125
• Piedmont Athens Regional Medical Center Hospital, Athens, GA, CCN 110074
• St Mary's Hospital Hospital, Athens, GA, CCN 110006
• Ty Cobb Regional Medical Center, LLC Hospital, Lavonia, GA, CCN 110027

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.

• Oconee Primary Care, L.L.C.

  • Internal Medicine Physician
  • Watkinsville, GA
  • NPI 1275860900
  Medicare reassignment Care Compare group NPD Authorized official
• Papp Clinic Laboratory

  • Clinical Medical Laboratory
  • Newnan, GA
  • NPI 1932353042
  NPD (past)

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

• Caresouth HHA Holdings of Washington, LLC

  dba Enhabit Home Health

  • Home Health Agency
  • Hartwell, GA
  • NPI 1740268176
  Care Compare affiliation
• Piedmont Athens Regional Medical Center, Inc.

  dba Piedmont Home Health

  • Home Health Agency
  • Athens, GA
  • NPI 1053306191
  Care Compare affiliation
• Piedmont Athens Regional Medical Center, Inc.

  • General Acute Care Hospital
  • Athens, GA
  • NPI 1437186111
  Care Compare affiliation
• St. Mary's Hospital, Inc.

  dba St. Mary's Hospital

  • General Acute Care Hospital
  • Athens, GA
  • NPI 1871556621
  Care Compare affiliation
• St. Mary's Sacred Heart Hospital, Inc.

  • Rural Acute Care Hospital
  • Lavonia, GA
  • NPI 1518354778
  Care Compare affiliation

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

{
    "created_epoch": "1133395200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1563494400000",
    "number": "1245214402",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1624 MARS HILL RD",
            "address_2": "SUITE B",
            "city": "WATKINSVILLE",
            "state": "GA",
            "postal_code": "306774813",
            "telephone_number": "706-310-1030",
            "fax_number": "706-705-1444"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1624 MARS HILL RD STE B",
            "city": "WATKINSVILLE",
            "state": "GA",
            "postal_code": "306774813",
            "telephone_number": "706-310-1030"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1199 Prince Ave",
            "address_purpose": "LOCATION",
            "city": "Athens",
            "state": "GA",
            "postal_code": "306062793",
            "country_code": "US",
            "telephone_number": "706-475-5076",
            "fax_number": "706-475-6676",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "PARK",
        "first_name": "KEN",
        "middle_name": "H.",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-12-01",
        "last_updated": "2019-07-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "GA",
            "license": "050049",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00904197A",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• George Glennwood Osgoodby Jr., DC
• Vanessa E Outlaw, LAPC
• Emily Corinne Overton
• Raven Oyagha
• Cathi Palmer
• James A Parker, MD
• Kimberly Koye Parker, NP
• Kelsey Parman, MS BCBA LBA
• Charmi D Patel, MD
• Navin L Patel, MD

• Internal Medicine Physician in Watkinsville, GA
• Providers in Watkinsville, GA by specialty
• Internal Medicine Physician in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 19, 2019; 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.