NPIMap

Individual provider Active NPI

Jason Park, MD

  • Orthopaedic Surgery Physician
  • Kingsport, TN
National Provider Identifier
1457554826
Registry record updated Sep 23, 2009
On this page

Key facts

NPPES NPI Registry
Primary specialty
Orthopaedic Surgery PhysicianTaxonomy code 207X00000X
License
42228 Issued in TN
Practice address
105 W Stone Dr
Ste 4B
Kingsport, TN 37660-3256
Phone
(423) 578-1570
NPI assigned
Jun 6, 2007
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 23, 2009

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Orthopaedic Surgery Physician 207X00000X 42228 TN Primary

Addresses

Primary practice location

105 W Stone Dr
Ste 4B
Kingsport, TN 37660-3256

Mailing address

PO Box 9
Kingsport, TN 37662-0009
Phone (423) 857-2091

Other identifiers 1

IdentifierTypeStateIssuer
3000606MedicaidTN

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TN
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
I20070917000098 TN Practitioner - Orthopedic Surgery 3577657972 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Orthopedic Surgery
Education
Wayne State University School of Medicine, 2002
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Holston Medical Group PCGroup PAC ID 8224935754, 239 clinicians
Dominion Health and Fitness, IncGroup PAC ID 3274570908, 71 clinicians

Practice addresses (Care Compare)

105 W Stone Dr
Kingsport, TN 37660-3256

240 Medical Park Blvd
Suite 1500
Bristol, TN 37620-7353
Phone (423) 990-2460

322 Steeles Rd
Bristol, TN 37620-9532
Phone (423) 217-1360

350 Steeles Rd
Unit 1
Bristol, TN 37620-9532
Phone (423) 844-4925

4862 Dickenson Hwy
PO Box 1810
Clintwood, VA 24228-1810

Hospital & facility affiliations

  • Amedisys Home Health Home health agency, Johnson City, TN, CCN 447422
  • Amedisys Home Health Care Home health agency, Abingdon, VA, CCN 497566
  • Centerwell Home Health Home health agency, Kingsport, TN, CCN 447254
  • Wellmont Holston Valley Medical Center Hospital, Kingsport, TN, CCN 440017
  • Lonesome Pine Hospital Hospital, Big Stone Gap, VA, CCN 490114
  • Johnston Memorial Hospital Hospital, Abingdon, VA, CCN 490053
  • Wellmont Bristol Regional Medical Center Hospital, Bristol, TN, CCN 440012
  • Johnson City Medical Center Hospital, Johnson City, TN, CCN 440063

Procedures performed for Medicare patients

ProcedureNumber of procedures
Hip replacement22
Knee replacement119
Lower limb (leg) arthroscopy (minimally invasive joint repair)1-10
Upper limb (arm) arthroscopy (minimally invasive joint repair)35
Removal of tissue1-10

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
42228TNMDOrthopaedic Surgery Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Holston Medical Group PC Orthopaedic Surgery CurrentSince Aug 22, 2007 Accepting new patients

Locations

350 Steeles Rd
#1
Bristol, TN 37620
Phone (423) 844-4925

2204 Pavilion Dr
Ste 200
Kingsport, TN 37660
Phone (423) 224-3900

105 W Stone Dr
Ste 4B
Kingsport, TN 37660
Phone (423) 578-1570

Interoperability endpoints

  • Direct secure messaging: jasonpark@hmgpath.allscriptsdirect.net

Organizations & group practices 2

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 10

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": "1181088000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1253664000000",
    "number": "1457554826",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 9",
            "city": "KINGSPORT",
            "state": "TN",
            "postal_code": "376620009",
            "telephone_number": "423-857-2091",
            "fax_number": "423-857-2012"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "105 W STONE DR",
            "address_2": "STE 4B",
            "city": "KINGSPORT",
            "state": "TN",
            "postal_code": "376603256",
            "telephone_number": "423-578-1570"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PARK",
        "first_name": "JASON",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-06-06",
        "last_updated": "2009-09-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207X00000X",
            "taxonomy_group": "",
            "desc": "Orthopaedic Surgery",
            "state": "TN",
            "license": "42228",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "3000606",
            "state": "TN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Kingsport, TN

Sources for this page

Verify at the official NPI Registry.