Individual provider Active NPI

Hyun Joo Park, M.D.

  • Neurological Surgery Physician
  • Vernon, CT
National Provider Identifier
1255021200
Registry record updated Jan 10, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Neurological Surgery PhysicianTaxonomy code 207T00000X
License
79484 Issued in CT
Practice address
35 Talcottville Rd Ste 5
Vernon, CT 06066-5261
Phone
(860) 870-6388
NPI assigned
May 12, 2023
Reactivated
Dec 27, 2023
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jan 10, 2025

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Student in an Organized Health Care Education/Training Program 390200000X P120306 NY
Neurological Surgery Physician 207T00000X 79484 CT Primary

Addresses

Primary practice location

35 Talcottville Rd Ste 5
Vernon, CT 06066-5261

Mailing address

1290 Silas Deane Highway
HHC - Cvo
Wethersfield, CT 06109

Other practice location 1

1468 Madison Avenue
Annenberg Building, 8th floor -Room 8-29
New York, NY 10029
Phone (212) 241-6267

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CT
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

Enrollment IDStateProvider typePAC IDDetails
I20250124000249 CT Practitioner - Neurosurgery 0446789291 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Neurosurgery
Education
Other, 2016
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Hartford Healthcare Medical Group Specialists PLLCGroup PAC ID 3173866241, 1,555 clinicians

Practice addresses (Care Compare)

1244 Storrs Rd
Road
Storrs, CT 06268-2200
Phone (860) 724-2579

80 Seymour St
Hartford, CT 06102-8000
Phone (860) 972-0549

Hospital & facility affiliations

  • Hartford Healthcare at Home Home health agency, East Hartford, CT, CCN 077041
  • Hartford Hospital Hospital, Hartford, CT, CCN 070025

Procedures performed for Medicare patients

ProcedureNumber of procedures
Spinal fusion23
Laminectomy or laminotomy (partial removal of spine bones)1-10

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
P120306NYMDStudent in an Organized Health Care Education/Training Program

Practice roles

OrganizationSpecialtyStatusNew patients
Hartford Healthcare Medical Group Specialists LLC CurrentSince Feb 1, 2025 Accepting new patients
Hartford Healthcare Medical Group Specialists, PLLC Neurological Surgery CurrentSince Feb 1, 2025 Accepting new patients

Locations

1244 Storrs Rd
Storrs Mansfield, CT 06268
Phone (860) 724-2579

35 Talcottville Rd
Ste 5
Vernon Rockville, CT 06066
Phone (860) 249-8711

1290 Silas Deane Hwy
Wethersfield, CT 06109
Phone (860) 972-6977

Organizations & group practices 2

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.

Hospital & facility affiliations 3

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

NPI Registry JSON

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

{
    "created_epoch": "1683849600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1736467200000",
    "number": "1255021200",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1290 SILAS DEANE HIGHWAY",
            "address_2": "HHC - CVO",
            "city": "WETHERSFIELD",
            "state": "CT",
            "postal_code": "06109"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "35 TALCOTTVILLE RD STE 5",
            "city": "VERNON",
            "state": "CT",
            "postal_code": "060665261",
            "telephone_number": "860-870-6388"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1468 Madison Avenue",
            "address_2": "Annenberg Building, 8th floor -Room 8-29",
            "address_purpose": "LOCATION",
            "city": "New York",
            "state": "NY",
            "postal_code": "10029",
            "country_code": "US",
            "telephone_number": "212-241-6267",
            "fax_number": "212-241-5608",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "PARK",
        "first_name": "HYUN JOO",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2023-05-12",
        "last_updated": "2025-01-10",
        "certification_date": "2025-01-08",
        "deactivation_date": "2023-12-18",
        "reactivation_date": "2023-12-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": "NY",
            "license": "P120306",
            "primary": false
        },
        {
            "code": "207T00000X",
            "taxonomy_group": "",
            "desc": "Neurological Surgery",
            "state": "CT",
            "license": "79484",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Vernon, CT

Sources for this page

Verify at the official NPI Registry.