Elisse Park, MD

Primary specialty

Ophthalmology PhysicianTaxonomy code 207W00000X

License

70012 Issued in CT

Practice address

2371 Black Rock Turnpike
Fairfield, CT 06825

Phone

(203) 371-0141

NPI assigned

Mar 26, 2018

Last updated

Sep 12, 2022By the provider in NPPES

Sex

Female

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 CT

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

Ophthalmology

Education

Georgetown University School of Medicine, 2018

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Ophthalmic Surgeons of GR BPT PCGroup PAC ID 7214968353, 6 clinicians

Practice addresses (Care Compare)

Merit-based Incentive Payment System (MIPS)

Final score

75 of 100Reported as group

Procedures performed for Medicare patients

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: eyp@ophthalmicsurgeons.ecldirect.net

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Ophthalmic Surgeons of GR BPT PC

  dba Optical Illusions

  • Ophthalmology Physician
  • Fairfield, CT
  • NPI 1619026671
  Medicare reassignment Care Compare group NPD

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

{
    "created_epoch": "1522022400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1662940800000",
    "number": "1366947061",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2371 BLACK ROCK TURNPIKE",
            "city": "FAIRFIELD",
            "state": "CT",
            "postal_code": "06825",
            "telephone_number": "203-371-0141"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2371 BLACK ROCK TURNPIKE",
            "city": "FAIRFIELD",
            "state": "CT",
            "postal_code": "06825",
            "telephone_number": "203-371-0141"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PARK",
        "first_name": "ELISSE",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2018-03-26",
        "last_updated": "2022-09-12",
        "certification_date": "2022-09-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207W00000X",
            "taxonomy_group": "",
            "desc": "Ophthalmology",
            "state": "CT",
            "license": "70012",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Mary Beth Paolillo, PT
• Regina Papa, OT
• Paradigm Medical Care, LLC
• Jonathan Paramo, MD
• Harvey Michael Paris, LCSW
• Yong Suel Park, DDS
• Parklane Opticians of Fairfield,Inc
• Lauren Parnoff, BCBA
• Pasquale J. Dematteo, D.O., P.C. (Fairfield Family Medical Care)
• Jo-Anne Passalacqua, M.D.

• Ophthalmology Physician in Fairfield, CT
• Providers in Fairfield, CT by specialty
• Ophthalmology Physician in Connecticut

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 12, 2022; 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.