Melissa Lee Park, MD

Primary specialty

Internal Medicine PhysicianTaxonomy code 207R00000X

License

M-10546 Issued in ID

Practice address

1203 Idaho St
Lewiston, ID 83501-1940

Phone

(509) 444-8888

NPI assigned

Jul 6, 2006

Last updated

Jul 22, 2020By 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 2

Addresses

Other identifiers 2

Other names 1

• Melissa Lee Broomhall Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

Practice roles

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.

• Caldwell Internal Medicine Professional Association

  • Internal Medicine Physician
  • Caldwell, ID
  • NPI 1649225616
  NPD (past)
• West Valley Medical Group Specialty Services LLC

  • Obesity Medicine (Obstetrics & Gynecology) Physician
  • Caldwell, ID
  • NPI 1245659093
  NPD (past)
• Melissa Park, MD Internal Medicine

  • Specialist
  • Rockport, ME
  • NPI 1114935855
  NPD (past)

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

{
    "created_epoch": "1152144000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1595376000000",
    "number": "1386676039",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "611 N IRON BRIDGE WAY",
            "city": "SPOKANE",
            "state": "WA",
            "postal_code": "992024932",
            "telephone_number": "509-444-8888"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1203 IDAHO ST",
            "city": "LEWISTON",
            "state": "ID",
            "postal_code": "835011940",
            "telephone_number": "509-444-8888"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "803 S Main St Ste 120",
            "address_purpose": "LOCATION",
            "city": "Moscow",
            "state": "ID",
            "postal_code": "838432695",
            "country_code": "US",
            "telephone_number": "208-459-4667",
            "fax_number": "208-459-3372",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "PARK",
        "first_name": "MELISSA",
        "middle_name": "LEE",
        "name_prefix": "Mrs.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-07-06",
        "last_updated": "2020-07-22",
        "certification_date": "2020-07-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "ME",
            "license": "015943",
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "ID",
            "license": "M-10546",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "431898000",
            "state": "ME"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "808286200",
            "state": "ID"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "MELISSA",
            "last_name": "BROOMHALL",
            "middle_name": "LEE",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Patrick Palkowski, MS, LAT, ATC
• Kyle Palmer, PT
• Jacob Pannell
• Sushma Pant, MD
• Michael K Parent, MD
• Leanne Parker, PHD
• Robert Todd Parkey, MD
• Bobby Leon Pascoe Jr.
• Pathologists Regional Laboratory
• Pathways Transport LLC

• Internal Medicine Physician in Lewiston, ID
• Providers in Lewiston, ID by specialty
• Internal Medicine Physician in Idaho

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.