NPIMap

Individual provider Active NPI

Jun Tae Park, M.D.

  • Neurology with Special Qualifications in Child Neurology Physician
  • Cleveland, OH
National Provider Identifier
1437333515
Registry record updated May 29, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Neurology with Special Qualifications in Child Neurology PhysicianTaxonomy code 2084N0402X
License
35-097398 Issued in OH
Practice address
11100 Euclid Ave
Cleveland, OH 44106-1716
Phone
(216) 844-7700
NPI assigned
Dec 24, 2007
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 29, 2013

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Neurology with Special Qualifications in Child Neurology Physician 2084N0402X 5922577-1205 UT
Neurology with Special Qualifications in Child Neurology Physician 2084N0402X 35-097398 OH Primary

Addresses

Primary practice location

11100 Euclid Ave
Cleveland, OH 44106-1716

Mailing address

24701 Euclid Ave
3Rd Floor
Euclid, OH 44117-1714

Other identifiers 1

IdentifierTypeStateIssuer
0063239MedicaidOH

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OH
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20130521000709 OH Practitioner - Neurology 8325215346 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Neurology
Education
Other, 2002
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
University Hospitals Medical Group IncGroup PAC ID 4789682493, 2,248 clinicians

Practice addresses (Care Compare)

11100 Euclid Ave
Cleveland, OH 44106-1716

13207 Ravenna Rd
Chardon, OH 44024-7032
Phone (440) 285-6000

29000 Ctr Ridge Rd
Westlake, OH 44145-5293
Phone (440) 835-8000

36000 Euclid Ave
Willoughby, OH 44094-4625
Phone (216) 844-3800

3999 Richmond Rd
Beachwood, OH 44122-6046
Phone (216) 593-5500

5850 Landerbrook Dr
Mayfield HTS, OH 44124-6531
Phone (440) 720-3250

Hospital & facility affiliations

  • Lake Health Hospital, Concord, OH, CCN 360098
  • Uh St John Medical Center Hospital, Westlake, OH, CCN 360123
  • Uh Cleveland Medical Center Hospital, Cleveland, OH, CCN 360137
  • University Hospitals Ahuja Medical Center Hospital, Beachwood, OH, CCN 360359
  • Uh Regional Hospitals Hospital, Chardon, OH, CCN 360075

Merit-based Incentive Payment System (MIPS)

Final score
81.19 of 100Reported as group
Quality
63.13
Promoting interoperability
100
Improvement activities
40
Cost
74.18

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
35-097398OHMDNeurology with Special Qualifications in Child Neurology Physician
5922577-1205UTMDNeurology with Special Qualifications in Child Neurology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
University Hospitals Medical Group Inc CurrentSince Apr 1, 2013 Accepting new patients
University Hospitals Cleveland Medical Center Past Accepting new patients
Multicare Health System Past Accepting new patients

Locations

11100 Euclid Ave
Cleveland Heights, OH 44106

24701 Euclid Ave
Fl 3
Euclid, OH 44117
Phone (216) 383-6950

5850 Landerbrook Dr
Ste 220
Mayfield Hts, OH 44124
Phone (216) 844-1765

32800 Lorain Rd
Ste 2200
North Ridgeville, OH 44039
Phone (440) 406-5475

Interoperability endpoints

  • Direct secure messaging: jpark35905@ehrdirect.uhhospitals.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.

Hospital & facility affiliations 8

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": "1198454400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1369785600000",
    "number": "1437333515",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "24701 EUCLID AVE",
            "address_2": "3RD FLOOR",
            "city": "EUCLID",
            "state": "OH",
            "postal_code": "441171714"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11100 EUCLID AVE",
            "city": "CLEVELAND",
            "state": "OH",
            "postal_code": "441061716",
            "telephone_number": "216-844-7700"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PARK",
        "first_name": "JUN",
        "middle_name": "TAE",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-12-24",
        "last_updated": "2013-05-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2084N0402X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Neurology with Special Qualifications in Child Neurology",
            "state": "UT",
            "license": "5922577-1205",
            "primary": false
        },
        {
            "code": "2084N0402X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Neurology with Special Qualifications in Child Neurology",
            "state": "OH",
            "license": "35-097398",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0063239",
            "state": "OH"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Cleveland, OH

Sources for this page

Verify at the official NPI Registry.