Individual provider Active NPI

Joseph Park, DPM

  • Foot & Ankle Surgery Podiatrist
  • Pomona, CA
National Provider Identifier
1306231600
Registry record updated Nov 5, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Foot & Ankle Surgery PodiatristTaxonomy code 213ES0103X
License
E5726 Issued in CA
Practice address
309 E 2ND St
Pomona, CA 91766-1854
Phone
(909) 623-6116
NPI assigned
Apr 2, 2015
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 5, 2021

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Foot & Ankle Surgery Podiatrist 213ES0103X E5726 CA Primary

Addresses

Primary practice location

309 E 2ND St
Pomona, CA 91766-1854

Mailing address

309 E 2ND St
Pomona, CA 91766-1854

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in GA, CA2 enrollments
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: No
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20181109001235 GA Practitioner - Podiatry 9234483223 Reassigns benefits to 1 organization
I20210430000455 CA Practitioner - Podiatry 9234483223 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Podiatry
Education
New York College of Podiatric Medicine, 2015
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
De Anza Orthopedic Medical Group IncGroup PAC ID 9739481375, 18 clinicians
Western University of Health SciencesGroup PAC ID 0648208991, 50 clinicians

Practice addresses (Care Compare)

26600 Cactus Ave
FL 2
Moreno Valley, CA 92555-3901
Phone (951) 486-4000

795 E 2ND St
Suite 7
Pomona, CA 91766-2007
Phone (909) 469-8673

Hospital & facility affiliations

  • Riverside University Health System-Medical Center Hospital, Moreno Valley, CA, CCN 050292

Merit-based Incentive Payment System (MIPS)

Final score
86.49 of 100Reported as group
Quality
68.78
Improvement activities
40
Cost
78.85

Procedures performed for Medicare patients

ProcedureNumber of procedures
Removal of tissue15
Removal of skin lesions1-10
Removal of nail tissue1-10
Removal or shaving of skin growth13

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
007034NYMDClinical Psychologist
E5726CAMDFoot & Ankle Surgery Podiatrist

Practice roles (6 of 7)

OrganizationSpecialtyStatusNew patients
De Anza Orthopedic Medical Group, Inc. CurrentSince Jul 1, 2024 Accepting new patients
The Southeast Permanente Medical Group CurrentSince Jul 30, 2018 Accepting new patients
Western University of Health Sciences Current Accepting new patients
Western University of Health Sciences CurrentSince Feb 1, 2021 Accepting new patients
Western University of Health Sciences Foot & Ankle Surgery CurrentSince Feb 1, 2021 Accepting new patients
Mark Brian Friedman, DPM, PLLC Past Accepting new patients

Locations

26600 Cactus Ave
Fl 2
Moreno Valley, CA 92555

26520 Cactus Ave
Moreno Valley, CA 92555
Phone (951) 486-5610

795 E 2nd St
Ste 2
Pomona, CA 91766
Phone (909) 469-8673

309 E 2nd St
Pomona, CA 91766
Phone (909) 469-5589

795 E 2nd St
Ste 8
Pomona, CA 91766
Phone (909) 469-8673

795 E 2nd St
Ste 5
Pomona, CA 91766
Phone (909) 706-3877

795 E 2nd St
Ste 7
Pomona, CA 91766
Phone (909) 469-8673

8686 Haven Ave
Ste 200
Rancho Cucamonga, CA 91730
Phone (909) 706-3950

3495 Piedmont Rd NE
Bldg 9
Atlanta, GA 30305
Phone (404) 364-7000

20 Glenlake Pkwy
Sandy Springs, GA 30328
Phone (770) 677-6247

Networks

  • BSC 65 PLUS INDIVIDUAL MAPD

Interoperability endpoints

  • Direct secure messaging: jpark417961@direct.llu.edu

Organizations & group practices 6

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 1

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": "1427932800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1636070400000",
    "number": "1306231600",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "309 E 2ND ST",
            "city": "POMONA",
            "state": "CA",
            "postal_code": "917661854"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "309 E 2ND ST",
            "city": "POMONA",
            "state": "CA",
            "postal_code": "917661854",
            "telephone_number": "909-623-6116"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PARK",
        "first_name": "JOSEPH",
        "name_prefix": "Dr.",
        "credential": "DPM",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2015-04-02",
        "last_updated": "2021-11-05",
        "certification_date": "2021-11-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "213ES0103X",
            "taxonomy_group": "",
            "desc": "Podiatrist, Foot & Ankle Surgery",
            "state": "CA",
            "license": "E5726",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Pomona, CA

Sources for this page

Verify at the official NPI Registry.