Robin S Park, MD

Primary specialty

Psychiatry PhysicianTaxonomy code 2084P0800X

License

R3M29 Issued in MO

Practice address

777 Craig Rd
Suite 100
Creve Coeur, MO 63141-7138

Phone

(314) 991-1033

Fax

(314) 991-1031

NPI assigned

Jul 13, 2006

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in MO

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

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

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

{
    "created_epoch": "1152748800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1363910400000",
    "number": "1407871213",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "777 CRAIG RD",
            "address_2": "SUITE 100",
            "city": "CREVE COEUR",
            "state": "MO",
            "postal_code": "631417138",
            "telephone_number": "314-991-1033",
            "fax_number": "314-991-1031"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "777 CRAIG RD",
            "address_2": "SUITE 100",
            "city": "CREVE COEUR",
            "state": "MO",
            "postal_code": "631417138",
            "telephone_number": "314-991-1033",
            "fax_number": "314-991-1031"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PARK",
        "first_name": "ROBIN",
        "middle_name": "S",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2006-07-13",
        "last_updated": "2013-03-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2084P0800X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "MO",
            "license": "R3M29",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "203592506",
            "state": "MO"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Psychiatry Physician in Creve Coeur, MO
• Providers in Creve Coeur, MO by specialty
• Psychiatry Physician in Missouri

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 22, 2013; 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.