Individual provider Active NPI

Trevor Parks, M.D

  • Internal Medicine Physician
  • Astoria, NY
National Provider Identifier
1457580771
Registry record updated Jul 8, 2009
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
003783 Issued in NY
Practice address
4904 19TH Ave
Astoria, NY 11105-1002
Phone
(718) 777-3494
NPI assigned
Jul 8, 2009
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 8, 2009

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X 003783 NY Primary

Addresses

Primary practice location

4904 19TH Ave
Astoria, NY 11105-1002

Mailing address

4904 19TH Ave
Astoria, NY 11105-1002
Phone (718) 777-3494

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in GA
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
I20210312000319 GA Order and Referring Only - Internal MedicinePractitioner - Internal Medicine 7517129745

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled
HHS exclusion list flag
Flagged The directory lists this NPI on an HHS exclusion list. The OIG exclusions file (LEIE) holds no record for this NPI, and the directory does not say which list the flag comes from. How exclusions are shown Confirm with the OIG exclusions search.
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
003783NYMDOrthopaedic Surgery Physician

Practice roles

OrganizationSpecialtyStatusNew patients
RLD Medical Services, PC Internal Medicine PastSince Jul 1, 2001 Accepting new patients
Forest Hills Dermatology Group PLLC PastSince Sep 1, 2012 Accepting new patients

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.

NPI Registry JSON

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

{
    "created_epoch": "1247011200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1247011200000",
    "number": "1457580771",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4904 19TH AVE",
            "city": "ASTORIA",
            "state": "NY",
            "postal_code": "111051002",
            "telephone_number": "718-777-3494"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4904 19TH AVE",
            "city": "ASTORIA",
            "state": "NY",
            "postal_code": "111051002",
            "telephone_number": "718-777-3494"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PARKS",
        "first_name": "TREVOR",
        "name_prefix": "Dr.",
        "credential": "M.D",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2009-07-08",
        "last_updated": "2009-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "NY",
            "license": "003783",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Astoria, NY

Sources for this page

Verify at the official NPI Registry.