Jennifer Park, M.D.

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

52982 Issued in AZ

Practice address

4545 E Chandler Blvd Ste 104
Phoenix, AZ 85048

Phone

(480) 728-4400

Fax

(480) 222-3422

NPI assigned

Jun 24, 2013

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in CA

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

Family Practice

Education

Other, 2013

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Group practices

Torrance Health Association IncGroup PAC ID 1355302134, 298 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Torrance Memorial Home Health Home health agency, Torrance, CA, CCN 057788
• Seaport Scripps Home Health Home health agency, San Diego, CA, CCN 057602
• Torrance Memorial Medical Center Hospital, Torrance, CA, CCN 050351

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

Networks

• BSC 65 PLUS INDIVIDUAL MAPD

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.

• Torrance Health Association Inc

  • Family Medicine Physician
  • Torrance, CA
  • NPI 1083903124
  Medicare reassignment Care Compare group NPD
• Dignity Health

  • General Acute Care Hospital
  • Phoenix, AZ
  • NPI 1982733655
  NPD (past)
• Torrance Memorial Medical Center

  • Skilled Nursing Facility
  • Torrance, CA
  • NPI 1740268713
  NPD (past)

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

• Rancho Bernardo Healthcare LLC

  • Home Health Agency
  • San Diego, CA
  • NPI 1750906954
  Care Compare affiliation
• Torrance Memorial Medical Center

  • General Acute Care Hospital
  • Torrance, CA
  • NPI 1467459776
  Care Compare affiliation
• Torrance Memorial Medical Center

  • Home Health Agency
  • Torrance, CA
  • NPI 1710989330
  Care Compare affiliation

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

{
    "created_epoch": "1372032000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1563235200000",
    "number": "1245679182",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3030 N CENTRAL AVE STE 1001",
            "city": "PHOENIX",
            "state": "AZ",
            "postal_code": "850122716",
            "telephone_number": "602-406-4786",
            "fax_number": "916-636-4358"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4545 E CHANDLER BLVD STE 104",
            "city": "PHOENIX",
            "state": "AZ",
            "postal_code": "85048",
            "telephone_number": "480-728-4400",
            "fax_number": "480-222-3422"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2927 N 7th Ave",
            "address_2": "Peppertree Building",
            "address_purpose": "LOCATION",
            "city": "Phoenix",
            "state": "AZ",
            "postal_code": "850134102",
            "country_code": "US",
            "telephone_number": "602-406-3153",
            "fax_number": "602-406-7176",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "2927 N 7th Ave",
            "address_2": "Peppertree Building",
            "address_purpose": "LOCATION",
            "city": "Phoenix",
            "state": "AZ",
            "postal_code": "850134102",
            "country_code": "US",
            "telephone_number": "602-406-3153",
            "fax_number": "602-406-7176",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "PARK",
        "first_name": "JENNIFER",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2013-06-24",
        "last_updated": "2019-07-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "AZ",
            "license": "R74065",
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "AZ",
            "license": "52982",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "TRAINING PERMIT",
            "identifier": "R74065",
            "state": "AZ"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Andrew S Park, PHARMD
• Cleopatra C Park, N.P.
• Connor Charles Park
• Donald W Park, M.D.
• Jae Hyun Park, DMD, PHD
• Jung K Park, M.D.
• Keun Hye Park
• Kwiok Gloria Park
• Michelle Hae-Min Park, DO
• Michelle M Park, MD

• Family Medicine Physician in Phoenix, AZ
• Providers in Phoenix, AZ by specialty
• Family Medicine Physician in Arizona

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 16, 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.