Individual provider Active NPI

Joshua Douglas Park, PA-C

  • Surgical Physician Assistant
  • Cherry Hill, NJ
National Provider Identifier
1457470833
Registry record updated Feb 1, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Surgical Physician AssistantTaxonomy code 363AS0400X
License
25MP00600700 Issued in NJ
Practice address
1 Brace Rd Ste H
Cherry Hill, NJ 08034
Phone
(856) 547-0389
Fax
(856) 428-4053
NPI assigned
Mar 28, 2007
Last updated
Feb 1, 2021By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 1, 2021

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X MA051536 PA
Surgical Physician Assistant 363AS0400X 25MP00600700 NJ Primary

Addresses

Primary practice location

1 Brace Rd Ste H
Cherry Hill, NJ 08034

Mailing address

301 Lippincott Dr Ste 410
Marlton, NJ 08053-4197
Phone (856) 355-0340

Other practice location 1

2004 Sproul Rd
Broomall, PA 19008-3511
Phone (610) 353-0800

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address jpark185260@directvirtua.org

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NJ, NY2 enrollments
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20210407000981 NJ Practitioner - Physician Assistant 5890740542 Reassigns benefits to 2 organizations
I20250110002527 NY Practitioner - Physician Assistant 5890740542 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2003
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Cooper Surgical Associates, PAGroup PAC ID 3274430764, 303 clinicians
New York UniversityGroup PAC ID 1355232422, 5,925 clinicians

Practice addresses (Care Compare)

1 Cooper PLZ
Camden, NJ 08103-1461

111 Broadway
New York, NY 10006-1901
Phone (212) 263-9700

150 55TH St
Brooklyn, NY 11220-2508
Phone (718) 630-7000

2 Cooper PLZ
Camden, NJ 08103-1461

3 Cooper PLZ
Camden, NJ 08103-1438

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
85.23 of 100Reported as group
Quality
77.64
Promoting interoperability
98
Improvement activities
40
Cost
68.41

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

State licenses

LicenseStateTypeSpecialty
25MP00600700NJMDSurgical Physician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
New York University CurrentSince Jan 21, 2025 Accepting new patients
New York University CurrentSince Jan 21, 2025 Accepting new patients
Virtua Medical Group, PA CurrentSince Feb 1, 2021 Accepting new patients
Cooper Surgical Associates, PA CurrentSince Apr 1, 2022 Accepting new patients
Virtua Medical Group, PA Physician Assistant CurrentSince Feb 1, 2021 Accepting new patients
Virtua Medical Group, PA Past Accepting new patients

Locations

3242 Route 206
Ste 2
Bordentown, NJ 08505
Phone (609) 298-4340

1 Cooper Plz
#A
Camden, NJ 08103
Phone (888) 499-8779

3 Cooper Plz
Rm 411
Camden, NJ 08103
Phone (856) 342-2270

1 Brace Rd
Ste H
Cherry Hill, NJ 08034
Phone (856) 470-9230

301 Lippincott Dr
Ste 410
Marlton, NJ 08053

700 Hicksville Rd
Ste 205
Bethpage, NY 11714
Phone (646) 501-3325

Networks

  • Healthfirst Medicare Network H5989
  • Healthfirst Medicare Network H1722
  • Healthfirst Medicare Network H9678
  • Healthfirst Medicare Network H3359

Interoperability endpoints

  • Direct secure messaging: jpark121943@direct.cooperhealth.edu
  • Direct secure messaging: jpark185260@directvirtua.org
  • Direct secure messaging: jpark684918@nyumc.direct-ci.com

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 7

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": "1175040000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1612137600000",
    "number": "1457470833",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "301 LIPPINCOTT DR STE 410",
            "city": "MARLTON",
            "state": "NJ",
            "postal_code": "080534197",
            "telephone_number": "856-355-0340",
            "fax_number": "856-355-0330"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1 BRACE RD STE H",
            "city": "CHERRY HILL",
            "state": "NJ",
            "postal_code": "08034",
            "telephone_number": "856-547-0389",
            "fax_number": "856-428-4053"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2004 Sproul Rd",
            "address_purpose": "LOCATION",
            "city": "Broomall",
            "state": "PA",
            "postal_code": "190083511",
            "country_code": "US",
            "telephone_number": "610-353-0800",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "PARK",
        "first_name": "JOSHUA",
        "middle_name": "DOUGLAS",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-03-28",
        "last_updated": "2021-02-01",
        "certification_date": "2021-02-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "PA",
            "license": "MA051536",
            "primary": false
        },
        {
            "code": "363AS0400X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Surgical",
            "state": "NJ",
            "license": "25MP00600700",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "jpark185260@directvirtua.org",
            "affiliation": "N",
            "address_1": "1 Brace Rd Ste H",
            "city": "Cherry Hill",
            "state": "NJ",
            "country_code": "US",
            "postal_code": "08034",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Cherry Hill, NJ

Sources for this page

Verify at the official NPI Registry.