SE Hun Park, ATC

Primary specialty

Physician AssistantTaxonomy code 363A00000X

Practice address

3401 W Gore Blvd
Lawton, OK 73505-6332

Phone

(580) 355-8620

NPI assigned

Aug 19, 2015

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in MO, TX, OK3 enrollments

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 3

Specialty

Physician Assistant

Education

Other, 2023

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Ies ER Oklahoma LLCGroup PAC ID 5395234678, 135 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Memorial Health Hospital, Lawton, OK, CCN 370056

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

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.

• Ies ER Oklahoma LLC

  • Emergency Medicine Physician
  • Tulsa, OK
  • NPI 1447148093
  Medicare reassignment Care Compare group NPD
• Mercy Hospital Springfield

  • General Acute Care Hospital
  • Springfield, MO
  • NPI 1043242159
  Medicare reassignment NPD
• Elite Hospital Partners of Oklahoma

  • Emergency Medicine Physician
  • Lawton, OK
  • NPI 1154104404
  Medicare reassignment
• Century Integrated Partners, Inc

  • Emergency Medicine Physician
  • Dallas, TX
  • NPI 1447615711
  Medicare reassignment
• Mercy Hospital Lebanon

  • General Acute Care Hospital
  • Lebanon, MO
  • NPI 1447284898
  Medicare reassignment
• Mercy Hospital Lebanon

  dba Mercy Surgery Center-Lebanon at Rolla

  • Ambulatory Surgical Clinic/Center
  • Rolla, MO
  • NPI 1043562358
  NPD
• Mercy Hospital Springfield

  • Medicare Defined Swing Bed Hospital Unit
  • Springfield, MO
  • NPI 1053907113
  NPD
• Comanche County Hospital Authority

  dba Comanche County Memorial Hospital

  • General Acute Care Hospital
  • Lawton, OK
  • NPI 1720022379
  NPD (past)

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

• Comanche County Hospital Authority

  dba CCMH Ambulance Services

  • Land Ambulance
  • Walters, OK
  • NPI 1285181610

  Hospital

  Care Compare affiliation
• Comanche County Hospital Authority

  dba Comanche County Memorial Hospital

  • General Acute Care Hospital
  • Lawton, OK
  • NPI 1720022379
  Care Compare affiliation
• Comanche County Hospital Authority

  dba CCMH Ambulance Services

  • Land Ambulance
  • Lawton, OK
  • NPI 1770525883

  Hospital

  Care Compare affiliation

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

{
    "created_epoch": "1439942400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1734652800000",
    "number": "1356717789",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3401 W GORE BLVD",
            "city": "LAWTON",
            "state": "OK",
            "postal_code": "735056332",
            "telephone_number": "580-355-8620"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3401 W GORE BLVD",
            "city": "LAWTON",
            "state": "OK",
            "postal_code": "735056332",
            "telephone_number": "580-355-8620"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PARK",
        "first_name": "SE HUN",
        "credential": "ATC",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2015-08-19",
        "last_updated": "2024-12-20",
        "certification_date": "2024-12-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2255A2300X",
            "taxonomy_group": "",
            "desc": "Specialist/Technologist, Athletic Trainer",
            "state": "MO",
            "license": "2015022932",
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Misty Panter, RN
• Emann Parent
• Vrajesh M Parikh, MD
• Park Ridge Physical Therapy, P.C.
• Jordan T Park
• Parker Place Home 1, LLC.
• Parker Place Home 2, LLC.
• Alexandra Parker
• Rebecca Ann Parker
• Timothy Leroy Parker Jr.

• Physician Assistant in Lawton, OK
• Providers in Lawton, OK by specialty
• Physician Assistant in Oklahoma

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