Jae Hyung Park

Primary specialty

Interventional Pain Medicine PhysicianTaxonomy code 208VP0014X

License

59983 Issued in AZ

Practice address

13203 N 103Rd Ave Ste H5
Sun City, AZ 85351-3032

Phone

(623) 777-4747

NPI assigned

Apr 10, 2015

Last updated

Sep 13, 2024By the provider in NPPES

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

Medicare fee-for-service enrollment

Enrolled in AZ

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

Interventional Pain Management

Education

Other, 2015

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Group practices

Novaspine Pain Institute PLCGroup PAC ID 9931323359, 20 clinicians

BHSM Rehabilitation LLCGroup PAC ID 2062773138, shared by 27 NPIs, 450 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Banner Boswell Medical Center Hospital, Sun City, AZ, CCN 030061

Merit-based Incentive Payment System (MIPS)

Final score

23.73 of 100Reported as individual

Quality

0

Promoting interoperability

0

Improvement activities

0

Cost

79.09

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

• Novaspine Pain Institute, PLC

  • Pain Medicine Physician
  • Sun City West, AZ
  • NPI 1154745263

  Anesthesiology

  Medicare reassignment Care Compare group NPD
• Avon Surgical Centers, LLC

  • Ambulatory Surgical Clinic/Center
  • Avondale, AZ
  • NPI 1891536991
  Medicare reassignment NPD
• Novaspine Pain Institute, PLC

  • Pain Medicine Physician
  • Sun City West, AZ
  • NPI 1265233019
  NPD

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

• Banner Boswell Medical Center

  • General Acute Care Hospital
  • Sun City, AZ
  • NPI 1952560914
  Care Compare affiliation

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

{
    "created_epoch": "1428624000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1726185600000",
    "number": "1255727889",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5281 N 99TH AVE STE 100",
            "city": "GLENDALE",
            "state": "AZ",
            "postal_code": "853052209",
            "telephone_number": "623-516-8252",
            "fax_number": "623-516-8253"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "13203 N 103RD AVE STE H5",
            "city": "SUN CITY",
            "state": "AZ",
            "postal_code": "853513032",
            "telephone_number": "623-777-4747"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "3110 Clearwater Dr Ste B",
            "address_purpose": "LOCATION",
            "city": "Prescott",
            "state": "AZ",
            "postal_code": "863057177",
            "country_code": "US",
            "telephone_number": "623-516-8252",
            "fax_number": "623-516-8253",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "PARK",
        "first_name": "JAE HYUNG",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2015-04-10",
        "last_updated": "2024-09-13",
        "certification_date": "2024-09-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208VP0014X",
            "taxonomy_group": "",
            "desc": "Pain Medicine, Interventional Pain Medicine",
            "state": "AZ",
            "license": "59983",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Theresa Pak, DO
• Srinivasa R Palnati, MD
• Timothy Michael Panknin, MD
• Paul M. Papoff, M.D.
• Mario T Parise, M.D.
• Cynthia M Parker, RD
• Shannon Nicole Parnett, RD
• Richard Gittings Parry, MD
• Partners Healthcare Home Medical Supplies, LLC
• Terrie Lyn Pasch, PA-C

• Interventional Pain Medicine Physician in Sun City, AZ
• Providers in Sun City, AZ by specialty
• Interventional Pain Medicine Physician in Arizona

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 13, 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.