Individual provider Active NPI

Jaeho Park, MD

  • Gastroenterology Physician
  • Little Rock, AR
National Provider Identifier
1477384287
Registry record updated Sep 13, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Gastroenterology PhysicianTaxonomy code 207RG0100X
License
E-18398 Issued in AR
Practice address
4301 W Markham St # 520
Little Rock, AR 72205-7101
Phone
(501) 686-8000
Fax
(501) 526-5148
NPI assigned
Aug 13, 2024
Last updated
Sep 13, 2024By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 13, 2024

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X E-18398 AR
Gastroenterology Physician 207RG0100X E-18398 AR Primary

Addresses

Primary practice location

4301 W Markham St # 520
Little Rock, AR 72205-7101

Mailing address

4301 W Markham St # 783
Little Rock, AR 72205-7101
Phone (501) 686-8000

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in FL, AR2 enrollments
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 2

Enrollment IDStateProvider typePAC IDDetails
I20240913001895 FL Practitioner - Gastroenterology 6507306727 Reassigns benefits to 1 organization
I20241011004080 AR Practitioner - GastroenterologyPractitioner - Internal Medicine 6507306727 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
GastroenterologyAlso: Internal Medicine
Education
Other, 2002
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

4301 W Markam St
Little Rock, AR 72205-7101
Phone (501) 686-8000

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Colonoscopy118
Upper gastrointestinal (GI) endoscopy for acid reflux119

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
University of Arkansas for Medical Sciences CurrentSince Sep 1, 2024 Accepting new patients
University of Florida Jacksonville Physicians, Inc. Internal Medicine Current Accepting new patients
University of Arkansas for Medical Sciences Internal Medicine Current Accepting new patients
University of Arkansas for Medical Sciences CurrentSince Sep 1, 2024 Accepting new patients
University of Florida Jacksonville Physicians Inc Gastroenterology CurrentSince Aug 16, 2024 Accepting new patients
University of Florida Jacksonville Physicians, Inc. CurrentSince Aug 16, 2024 Accepting new patients

Locations

4301 W Markham St
Little Rock, AR 72205
Phone (501) 603-1278

4301 W Markham St
#520
Little Rock, AR 72205
Phone (501) 686-5205

4301 W Markham St
#783
Little Rock, AR 72205
Phone (501) 603-1278

2001 Kingsley Ave
Orange Park, FL 32073
Phone (904) 215-7015

Organizations & group practices 6

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 1

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": "1723507200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1726185600000",
    "number": "1477384287",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4301 W MARKHAM ST # 783",
            "city": "LITTLE ROCK",
            "state": "AR",
            "postal_code": "722057101",
            "telephone_number": "501-686-8000",
            "fax_number": "501-526-5128"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4301 W MARKHAM ST # 520",
            "city": "LITTLE ROCK",
            "state": "AR",
            "postal_code": "722057101",
            "telephone_number": "501-686-8000",
            "fax_number": "501-526-5148"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PARK",
        "first_name": "JAEHO",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2024-08-13",
        "last_updated": "2024-09-13",
        "certification_date": "2024-09-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "AR",
            "license": "E-18398",
            "primary": false
        },
        {
            "code": "207RG0100X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Gastroenterology",
            "state": "AR",
            "license": "E-18398",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Little Rock, AR

Sources for this page

Verify at the official NPI Registry.