Individual provider Active NPI

Eunjin Lynn Park, CRNA

  • Certified Registered Nurse Anesthetist
  • Cary, NC
National Provider Identifier
1407226749
Registry record updated Mar 14, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Certified Registered Nurse AnesthetistTaxonomy code 367500000X
License
109893 Issued in NC
Practice address
1900 Kildaire Farm Rd
Cary, NC 27518-6616
Phone
(919) 350-8000
NPI assigned
Sep 29, 2015
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Mar 14, 2016

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

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
Registered Nurse 163W00000X RN1020191 DC
Registered Nurse 163W00000X 0001226040 VA
Student in an Organized Health Care Education/Training Program 390200000X
Certified Registered Nurse Anesthetist 367500000X 109893 NC Primary

Addresses

Primary practice location

1900 Kildaire Farm Rd
Cary, NC 27518-6616

Mailing address

3100 Spring Forest Rd
Ste 130
Raleigh, NC 27616-2880
Phone (919) 882-0706

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NC

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20160420001445 NC Practitioner - Certified Registered Nurse Anesthetist (Crna) 5294033593 Reassigns benefits to 4 organizations

Care Compare profile

Medicare Care Compare
Specialty
Certified Registered Nurse Anesthetist (Crna)
Education
Georgetown University School of Medicine, 2015
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Duke Health Integrated Practice IncGroup PAC ID 8325412737, 3,140 clinicians

Practice addresses (Care Compare)

3400 Wake Forest Rd
Suite 310
Raleigh, NC 27609-7317
Phone (919) 620-4855

40 Duke Medicine Cir
Durham, NC 27710-4000
Phone (919) 684-8111

Hospital & facility affiliations

  • Duke University Hospital Hospital, Durham, NC, CCN 340030

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Certified Registered Nurse

State licenses

LicenseStateTypeSpecialty
5377NCMDPsychologist
RN1020191DCMDRegistered Nurse
0001226040VAMDRegistered Nurse
109893NCMDCertified Registered Nurse Anesthetist

Practice roles

OrganizationSpecialtyStatusNew patients
Duke Health Integrated Practice, Inc. CurrentSince Jul 1, 2023 Accepting new patients
Regional Anesthesia, PLLC CurrentSince Jan 11, 2021 Accepting new patients
American Anesthesiology of North Carolina, PLLC Anesthesiology CurrentSince Mar 14, 2016 Accepting new patients
East Carolina Anesthesia Associates, PLLC Registered Nurse CurrentSince Sep 1, 2023 Accepting new patients
American Anesthesiology of North Carolina, PLLC Anesthesiology CurrentSince Mar 14, 2016 Accepting new patients

Locations

1900 Kildaire Farm Rd
Cary, NC 27518
Phone (919) 350-2300

40 Duke Medicine Cir
Durham, NC 27710
Phone (919) 681-6588

3643 N Roxboro St
Durham, NC 27704
Phone (919) 470-6186

2430 Emerald Pl
Ste 103
Greenville, NC 27834
Phone (252) 752-2140

3000 New Bern Ave
Raleigh, NC 27610
Phone (919) 350-7000

3100 Spring Forest Rd
Ste 130
Raleigh, NC 27616
Phone (919) 882-0705

4420 Lake Boone Trl
Raleigh, NC 27607
Phone (919) 784-3034

8300 Health Park
Ste 309
Raleigh, NC 27615
Phone (919) 571-1925

Organizations & group practices 5

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.

Hospital & facility affiliations 6

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

NPI Registry JSON

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

{
    "created_epoch": "1443484800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1457913600000",
    "number": "1407226749",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3100 SPRING FOREST RD",
            "address_2": "STE 130",
            "city": "RALEIGH",
            "state": "NC",
            "postal_code": "276162880",
            "telephone_number": "919-882-0706"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1900 KILDAIRE FARM RD",
            "city": "CARY",
            "state": "NC",
            "postal_code": "275186616",
            "telephone_number": "919-350-8000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PARK",
        "first_name": "EUNJIN",
        "middle_name": "LYNN",
        "credential": "CRNA",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2015-09-29",
        "last_updated": "2016-03-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "163W00000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse",
            "state": "DC",
            "license": "RN1020191",
            "primary": false
        },
        {
            "code": "163W00000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse",
            "state": "VA",
            "license": "0001226040",
            "primary": false
        },
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "367500000X",
            "taxonomy_group": "",
            "desc": "Nurse Anesthetist, Certified Registered",
            "state": "NC",
            "license": "109893",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Cary, NC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 14, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • 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.