Individual provider Active NPI

Andrew Yong-Woo Park, M.D.

  • Internal Medicine Physician
  • Festus, MO
National Provider Identifier
1427113729
Registry record updated Jul 21, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
2021015735 Issued in MO
Practice address
1400 US Highway 61
Festus, MO 63028-4100
Phone
(636) 933-5337
NPI assigned
Dec 27, 2006
Last updated
Jul 21, 2021By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 21, 2021

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X 047900 CT
Internal Medicine Physician 207R00000X RT1630 NH
Internal Medicine Physician 207R00000X 2021015735 MO Primary

Addresses

Primary practice location

1400 US Highway 61
Festus, MO 63028-4100

Mailing address

1400 US Highway 61
Festus, MO 63028-4100
Phone (636) 933-5337

Medicare participation

Medicare enrollment files
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

Enrollment IDStateProvider typePAC IDDetails
I20210726003497 MO Practitioner - Internal Medicine 9931248366 Reassigns benefits to 5 organizations

Care Compare profile

Medicare Care Compare
Specialty
Internal Medicine
Education
Other, 2006
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Mercy Clinic Adult Hospitalists Jefferson LLCGroup PAC ID 8628205598, 58 clinicians

Practice addresses (Care Compare)

1400 US Hwy 61
Festus, MO 63028-4100
Phone (636) 933-8091

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
7843SDMDProfessional Counselor
RT1630NHMDInternal Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Mercy Clinic Adult Hospitalists- Jefferson, LLC Internal Medicine CurrentSince Jul 21, 2021 Accepting new patients
St Anthonys Physician Organization Hospitalist Services, L.C. CurrentSince Jul 21, 2021 Accepting new patients
Mercy Clinic Adult Hospitalists - St. Louis, LLC Internal Medicine CurrentSince Jul 21, 2021 Accepting new patients
Mercy Hospitals East Communities CurrentSince Jul 21, 2021 Accepting new patients
Mercy Hospitals East Communities CurrentSince Jul 21, 2021 Accepting new patients
Mercy Clinic Adult Hospitalists - Washington, LLC CurrentSince Jul 21, 2021 Accepting new patients
Mercy Hospital Jefferson Past Accepting new patients

Locations

1400 US Highway 61
Crystal Cty, MO 63028
Phone (636) 933-1111

10010 Kennerly Rd
Saint Louis, MO 63128
Phone (314) 525-1328

615 S New Ballas Rd
Saint Louis, MO 63141
Phone (314) 251-4687

615 S New Ballas Rd
#H
Saint Louis, MO 63141
Phone (314) 251-6075

901 E 5th St
Washington, MO 63090
Phone (636) 239-8000

Organizations & group practices 7

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.

Hospital & facility affiliations 2

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": "1167177600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1626825600000",
    "number": "1427113729",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1400 US HIGHWAY 61",
            "city": "FESTUS",
            "state": "MO",
            "postal_code": "630284100",
            "telephone_number": "636-933-5337"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1400 US HIGHWAY 61",
            "city": "FESTUS",
            "state": "MO",
            "postal_code": "630284100",
            "telephone_number": "636-933-5337"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PARK",
        "first_name": "ANDREW",
        "middle_name": "YONG-WOO",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-12-27",
        "last_updated": "2021-07-21",
        "certification_date": "2021-07-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "CT",
            "license": "047900",
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "NH",
            "license": "RT1630",
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "MO",
            "license": "2021015735",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Festus, MO

Sources for this page

Verify at the official NPI Registry.