Sung Jae Park, M.D.

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

01051341 Issued in IN

Practice address

2235 Dubois Dr
Warsaw, IN 46580-3212

Phone

(574) 267-8189

Fax

(574) 267-7554

NPI assigned

Mar 1, 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

Other identifiers 1

Electronic endpoints 1

Medicare fee-for-service enrollment

Enrolled in IN

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

Family Practice

Education

Loma Linda University School of Medicine, 1996

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Group practices

Kosciusko Medical Group LLCGroup PAC ID 5496809956, 41 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Elara Caring Home health agency, Fort Wayne, IN, CCN 157243
• Kosciusko Community Hospital Hospital, Warsaw, IN, CCN 150133
• Parkview Whitley Hospital Hospital, Columbia City, IN, CCN 150101

Merit-based Incentive Payment System (MIPS)

Final score

90.99 of 100Reported as apm

Quality

77.41

Promoting interoperability

100

Improvement activities

40

Procedures performed for Medicare patients

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

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 and National Provider Directory roles.

• Kosciusko Medical Group LLC

  • Family Medicine Physician
  • Warsaw, IN
  • NPI 1932349594
  Medicare reassignment Care Compare group NPD
• Major Hospital

  • General Acute Care Hospital
  • Shelbyville, IN
  • NPI 1174555692
  NPD (past)

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

• A. C. & Associates, Inc.

  • Home Health Agency
  • Fort Wayne, IN
  • NPI 1013956440
  Care Compare affiliation
• Warsaw Health System LLC

  • General Acute Care Hospital
  • Warsaw, IN
  • NPI 1164475711
  Care Compare affiliation
• Whitley Memorial Hospital, Inc.

  • General Acute Care Hospital
  • Columbia City, IN
  • NPI 1205844495
  Care Compare affiliation
• Whitley Memorial Hospital, Inc.

  • Land Ambulance
  • Columbia City, IN
  • NPI 1497764450

  Hospital

  Care Compare affiliation

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

{
    "created_epoch": "1141171200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1601942400000",
    "number": "1336116201",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2235 DUBOIS DR",
            "city": "WARSAW",
            "state": "IN",
            "postal_code": "465803212",
            "telephone_number": "574-267-8189",
            "fax_number": "574-267-7554"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2235 DUBOIS DR",
            "city": "WARSAW",
            "state": "IN",
            "postal_code": "465803212",
            "telephone_number": "574-267-8189",
            "fax_number": "574-267-7554"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PARK",
        "first_name": "SUNG",
        "middle_name": "JAE",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-03-01",
        "last_updated": "2020-10-06",
        "certification_date": "2020-10-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "IN",
            "license": "01051341",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "200248760A",
            "state": "IN"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "sung.park@lutheranhealthnetwork.cernerdirect.com",
            "affiliation": "N",
            "endpointDescription": "AMR direct address",
            "address_1": "2235 Dubois Dr",
            "city": "Warsaw",
            "state": "IN",
            "country_code": "US",
            "postal_code": "465803212",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Cierra Ousley
• Jaimie M Ove, MA
• Alta Jane Overholser, MA, LMHC
• PA Labs Inc
• Bohyun Park, MA
• Amber Rae Parker, PTA
• Kellie R. Parker, NP
• Kimberly Parker, RN
• Marlene Parker, HSPP
• Parkview Kosciusko Surgery One, LLC

• Family Medicine Physician in Warsaw, IN
• Providers in Warsaw, IN by specialty
• Family Medicine Physician in Indiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 6, 2020; 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.