James D Park, DOM

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

2074 Issued in NM

Practice address

6501 Eagle Rock Ave NE
Suite A6
Albuquerque, NM 87113-2478

Phone

(505) 797-5400

Fax

(505) 797-2905

NPI assigned

Apr 19, 2006

Last updated

Sep 20, 2012By 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

Other identifiers 3

Medicare fee-for-service enrollment

Enrolled in NM

Enrollment records 1

Specialty

Physical Therapist in Private Practice

Education

Other, 1993

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

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.

• East West Integrated Pain & Rehab Center LLC

  • Physical Therapist
  • Albuquerque, NM
  • NPI 1932398146

  Acupuncturist

  Medicare reassignment NPD Authorized official
• James Park

  • Physical Therapist
  • Albuquerque, NM
  • NPI 1467704957
  Authorized official Same address or phone
• Kokopelli East West Integrated Family Healthcare, LLC

  • Occupational Therapy Assistant
  • Rio Rancho, NM
  • NPI 1396964318
  Authorized official Same address or phone
• Kokopelli East West Integrated Family Walk-in Clinic, LLC

  • Physical Therapist
  • Albuquerque, NM
  • NPI 1962575712

  Acupuncturist

  NPD (past) Authorized official

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

{
    "created_epoch": "1145404800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1348099200000",
    "number": "1255396719",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7343 WILD OLIVE AVE NE",
            "city": "ALBUQUERQUE",
            "state": "NM",
            "postal_code": "871132079",
            "telephone_number": "505-514-2900",
            "fax_number": "505-884-5159"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6501 EAGLE ROCK AVE NE",
            "address_2": "SUITE A6",
            "city": "ALBUQUERQUE",
            "state": "NM",
            "postal_code": "871132478",
            "telephone_number": "505-797-5400",
            "fax_number": "505-797-2905"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PARK",
        "first_name": "JAMES",
        "middle_name": "D",
        "name_prefix": "Dr.",
        "credential": "DOM",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-04-19",
        "last_updated": "2012-09-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "171100000X",
            "taxonomy_group": "",
            "desc": "Acupuncturist",
            "state": "NM",
            "license": "866 RX-1",
            "primary": false
        },
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "NM",
            "license": "2074",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS PT PROVIDER NUMBER",
            "identifier": "NM 00Q502",
            "state": "NM"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS DOM PROVIDER NUMBER",
            "identifier": "NM 00RH82",
            "state": "NM"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "45139024",
            "state": "NM"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Ashley Park, LCSW
• Christine S. Park
• Daniel Matthew Park, PHARM.D.
• Heather Leigh Park, OT
• Hyunjung Park
• Joo-Hee G Park, DO
• Luke Sungwoo Park, MD
• Sarah Youna Park
• Starla Kay Park, PHARMD
• Yeojin Park, MD STUDENT

• Physical Therapist in Albuquerque, NM
• Providers in Albuquerque, NM by specialty
• Physical Therapist in New Mexico

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 20, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• 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.