Sean S Park, MD

Primary specialty

Internal Medicine PhysicianTaxonomy code 207R00000X

License

A70333 Issued in CA

Practice address

444 Bruce St
Yreka, CA 96097-3450

Phone

(702) 453-3799

Fax

(702) 453-5741

NPI assigned

Oct 2, 2006

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 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

Internal Medicine

Education

University of Vermont College of Medicine, 1998

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Southern Mono Health Care DistrictGroup PAC ID 9830002401, 94 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Mammoth Hospital Hospital, Mammoth Lakes, CA, CCN 051303

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

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.

• Southern Mono Health Care District

  • Critical Access Hospital Clinic/Center
  • Mammoth Lakes, CA
  • NPI 1962444059

  CA

  Medicare reassignment Care Compare group NPD
• Southern Mono Health Care District

  • Rural Acute Care Hospital
  • Mammoth Lakes, CA
  • NPI 1053456400
  Care Compare group
• Visiting MD Inc

  • Specialist
  • San Diego, CA
  • NPI 1356715924
  NPD (past)

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

• Southern Mono Health Care District

  • Critical Access Hospital Clinic/Center
  • Mammoth Lakes, CA
  • NPI 1962444059

  Hospital

  Care Compare affiliation

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

{
    "created_epoch": "1159747200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1421712000000",
    "number": "1316031883",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 16102",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921766102",
            "telephone_number": "702-453-3799",
            "fax_number": "702-453-5741"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "444 BRUCE ST",
            "city": "YREKA",
            "state": "CA",
            "postal_code": "960973450",
            "telephone_number": "702-453-3799",
            "fax_number": "702-453-5741"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PARK",
        "first_name": "SEAN",
        "middle_name": "S",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-10-02",
        "last_updated": "2015-01-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "CA",
            "license": "A70333",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Annemarie O'Reilly, LCSW
• Catherine C. Olivolo, FNP
• Allison R Ortiz, RDH
• Angela Osterlund, CASE MANAGER
• Gerald Wayne Overstreet
• Manika S Paul
• Katarina Baltayan Pautz
• Laurie Marie Pedro Robustellini
• Performance Physical Therapy
• Cally Elizabeth Perkins, FNP-C

• All providers in Yreka, CA
• Internal Medicine Physician in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 20, 2015; 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.