Individual provider Active NPI

Jeffrey M Park, PA-C

  • Physician Assistant
  • Buffalo, NY
National Provider Identifier
1376581561
Registry record updated Oct 24, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
007902 Issued in NY
Practice address
701 Seneca St Ste 646C
Buffalo, NY 14210-1351
Phone
(716) 995-4450
NPI assigned
Jun 2, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 24, 2019

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X 007902 NY Primary

Addresses

Primary practice location

701 Seneca St Ste 646C
Buffalo, NY 14210-1351

Mailing address

100 High St
Dept. of Emergency Medicine
Buffalo, NY 14203-1126
Phone (716) 859-1993

Other practice location 1

100 High St
Emergency Dept.
Buffalo, NY 14203-1126
Phone (716) 859-1993

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NY
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 1

Enrollment IDStateProvider typePAC IDDetails
I20040728000954 NY Practitioner - Physician Assistant 2668442559 Reassigns benefits to 2 organizations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

State licenses

LicenseStateTypeSpecialty
007902NYMDMental Health Counselor
7902NYMDSpecialist

Practice roles

OrganizationSpecialtyStatusNew patients
Mercy Hospital of Buffalo CurrentSince Dec 3, 2012 Accepting new patients
Mercy Hospital of Buffalo CurrentSince Dec 3, 2012 Accepting new patients

Locations

565 Abbott Rd
Buffalo, NY 14220
Phone (716) 826-7000

144 Genesee St
Fl 3
Buffalo, NY 14203
Phone (716) 601-3690

Interoperability endpoints

  • Direct secure messaging: jpark@landmarkhealth-direct.org

Organizations & group practices 3

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.

NPI Registry JSON

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

{
    "created_epoch": "1149206400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1571875200000",
    "number": "1376581561",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "100 HIGH ST",
            "address_2": "DEPT. OF EMERGENCY MEDICINE",
            "city": "BUFFALO",
            "state": "NY",
            "postal_code": "142031126",
            "telephone_number": "716-859-1993"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "701 SENECA ST STE 646C",
            "city": "BUFFALO",
            "state": "NY",
            "postal_code": "142101351",
            "telephone_number": "716-995-4450"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "100 High St",
            "address_2": "Emergency Dept.",
            "address_purpose": "LOCATION",
            "city": "Buffalo",
            "state": "NY",
            "postal_code": "142031126",
            "country_code": "US",
            "telephone_number": "716-859-1993",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "PARK",
        "first_name": "JEFFREY",
        "middle_name": "M",
        "name_prefix": "Mr.",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-06-02",
        "last_updated": "2019-10-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "NY",
            "license": "007902",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Buffalo, NY

Sources for this page

Verify at the official NPI Registry.