Individual provider Active NPI

Kevin Wilson Parks, M.D.

  • Allergy Physician
  • Medford, OR
National Provider Identifier
1467499475
Registry record updated Dec 18, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Allergy PhysicianTaxonomy code 207KA0200X
License
MD26375 Issued in OR
Practice address
3860 Crater Lake Ave
Suite a
Medford, OR 97504-9741
Phone
(541) 858-1003
Fax
(541) 857-4499
NPI assigned
May 31, 2006
Last updated
Dec 18, 2013By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 18, 2013

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Allergy Physician 207KA0200X MD26375 OR Primary

Addresses

Primary practice location

3860 Crater Lake Ave
Suite a
Medford, OR 97504-9741

Mailing address

3860 Crater Lake Ave
Suite a
Medford, OR 97504-9741
Phone (541) 858-1003

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OR
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
I20070503000169 OR Practitioner - Allergy/ImmunologyPractitioner - Internal Medicine 8022072511 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Allergy/Immunology
Education
University of California, San Diego School of Medicine, 2001
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

1813 W Harvard Ave
Suite 241
Roseburg, OR 97471-8708
Phone (541) 858-1003

2628 Clover St
Klamath Falls, OR 97601-1132
Phone (541) 858-1003

3860 Crater Lake Ave
Suite a
Medford, OR 97504-9741
Phone (541) 858-1003

3860 Crater Lake Ave a
Medford, OR 97504-9741

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
26.18 of 100Reported as individual
Quality
0
Improvement activities
0
Cost
87.26

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
MD26375ORMDAllergy Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Allergy & Asthma Center of Southern Oregon PC Allergy CurrentSince Mar 29, 2007 Accepting new patients
Allergy & Asthma Center of Southern Oregon PC Allergy Current Accepting new patients
Allergy & Asthma Center of Southern Oregon PC Allergy CurrentSince Mar 29, 2007 Accepting new patients

Locations

2628 Clover St
Klamath Falls, OR 97601
Phone (541) 858-1003

3860 Crater Lake Ave
Medford, OR 97504
Phone (541) 858-1003

3860 Crater Lake Ave
Ste A
Medford, OR 97504
Phone (541) 858-1003

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 6

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": "1149033600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1387324800000",
    "number": "1467499475",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3860 CRATER LAKE AVE",
            "address_2": "SUITE A",
            "city": "MEDFORD",
            "state": "OR",
            "postal_code": "975049741",
            "telephone_number": "541-858-1003",
            "fax_number": "541-857-4499"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3860 CRATER LAKE AVE",
            "address_2": "SUITE A",
            "city": "MEDFORD",
            "state": "OR",
            "postal_code": "975049741",
            "telephone_number": "541-858-1003",
            "fax_number": "541-857-4499"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PARKS",
        "first_name": "KEVIN",
        "middle_name": "WILSON",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-05-31",
        "last_updated": "2013-12-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207KA0200X",
            "taxonomy_group": "",
            "desc": "Allergy & Immunology, Allergy",
            "state": "OR",
            "license": "MD26375",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Medford, OR

Sources for this page

Verify at the official NPI Registry.