NPIMap

Individual provider Active NPI

Jong Ho Park, M.D., M.P.H

  • Vascular & Interventional Radiology Physician
  • Lakeland, FL
National Provider Identifier
1326208034
Registry record updated Jun 17, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Vascular & Interventional Radiology PhysicianTaxonomy code 2085R0204X
License
ME119926 Issued in FL
Practice address
2125 Crystal Grove Dr
Lakeland, FL 33801-6875
Phone
(863) 688-2334
NPI assigned
Jun 16, 2008
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 17, 2014

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Diagnostic Radiology Physician 2085R0202X 254362 NY
Vascular & Interventional Radiology Physician 2085R0204X ME119926 FL Primary

Addresses

Primary practice location

2125 Crystal Grove Dr
Lakeland, FL 33801-6875

Mailing address

9707 63Rd Rd Apt 3L
Rego Park, NY 11374-1610
Phone (718) 278-5138

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in FL
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20140814001152 FL Practitioner - Diagnostic Radiology 1658598685 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Diagnostic Radiology
Education
State University of New York Downstate Medical Center, 2008
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Baycare Outpatient Imaging LLCGroup PAC ID 3577804087, 90 clinicians

Practice addresses (Care Compare)

2120 Lakeland Hills Blvd
Lakeland, FL 33805-2906
Phone (863) 688-2334

635 1St St N
Suite 101
Winter Haven, FL 33881-4129
Phone (863) 298-3512

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
86.74 of 100Reported as group
Quality
85
Improvement activities
40
Cost
74.49

Merit-based Incentive Payment System (MIPS)

Final score
71.5 of 100Reported as group
Quality
66.47
Improvement activities
40

Procedures performed for Medicare patients

ProcedureNumber of procedures
Leg revascularization (restoring blood flow)22

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
254362NYMDDiagnostic Radiology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Baycare Outpatient Imaging LLC Diagnostic Radiology CurrentSince Dec 2, 2023 Accepting new patients
Manatee Memorial Hospital L P Current Accepting new patients
Baycare Outpatient Imaging LLC Diagnostic Radiology Current Accepting new patients
Manatee Memorial Hospital L P CurrentSince Feb 25, 2018 Accepting new patients
Manatee Memorial Hospital L P CurrentSince Jan 31, 2018 Accepting new patients
Manatee Memorial Hospital LP CurrentSince Feb 25, 2018 Accepting new patients
Baycare Outpatient Imaging LLC Diagnostic Radiology CurrentSince Dec 2, 2023 Accepting new patients

Locations

206 2nd St E
Bradenton, FL 34208
Phone (941) 745-7202

18600 Fernview St
Ste 101
Land O Lakes, FL 34638
Phone (813) 692-8010

2470 Bloomingdale Ave
Ste 115
Valrico, FL 33596
Phone (727) 281-9479

635 1st St N
Ste 101
Winter Haven, FL 33881
Phone (863) 298-3512

Networks

  • Freedom Health HMO Network
  • Optimum HealthCare HMO Network

Organizations & group practices 8

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": "1213574400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1402963200000",
    "number": "1326208034",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9707 63RD RD APT 3L",
            "city": "REGO PARK",
            "state": "NY",
            "postal_code": "113741610",
            "telephone_number": "718-278-5138"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2125 CRYSTAL GROVE DR",
            "city": "LAKELAND",
            "state": "FL",
            "postal_code": "338016875",
            "telephone_number": "863-688-2334"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PARK",
        "first_name": "JONG HO",
        "name_prefix": "Dr.",
        "credential": "M.D., M.P.H",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2008-06-16",
        "last_updated": "2014-06-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2085R0202X",
            "taxonomy_group": "",
            "desc": "Radiology, Diagnostic Radiology",
            "state": "NY",
            "license": "254362",
            "primary": false
        },
        {
            "code": "2085R0204X",
            "taxonomy_group": "",
            "desc": "Radiology, Vascular & Interventional Radiology",
            "state": "FL",
            "license": "ME119926",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Lakeland, FL

Sources for this page

Verify at the official NPI Registry.