NPIMap

Individual provider Active NPI

Jesse Aaron Park

  • Emergency Medicine Physician
  • Wyandotte, MI
National Provider Identifier
1487079190
Registry record updated Feb 29, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Emergency Medicine PhysicianTaxonomy code 207P00000X
License
5101020914 Issued in MI
Practice address
2333 Biddle Ave
Wyandotte, MI 48192-4668
Phone
(734) 287-9029
NPI assigned
Mar 4, 2014
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 29, 2024

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Emergency Medicine Physician 207P00000X 5101020914 MI Primary

Addresses

Primary practice location

2333 Biddle Ave
Wyandotte, MI 48192-4668

Mailing address

2333 Biddle Ave
Wyandotte, MI 48192-4668
Phone (734) 287-9029

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MI, OH2 enrollments
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20161004002844 MI Practitioner - Emergency Medicine 8527285253 Reassigns benefits to 1 organization
I20220816003436 OH Practitioner - Emergency Medicine 8527285253 Reassigns benefits to 4 organizations

Care Compare profile

Medicare Care Compare
Specialty
Emergency Medicine
Education
Michigan State University College of Osteopathic Medicine, 2014
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
The Toledo HospitalGroup PAC ID 2961309638, 118 clinicians
Emergency Physicians of Northwest Ohio, Inc.Group PAC ID 3375456478, 102 clinicians
Observation Physicians of Northwest Ohio LLCGroup PAC ID 7416365630, 37 clinicians

Practice addresses (Care Compare)

1075 Medical Ctr Pkwy
Maumee, OH 43537
Phone (567) 585-0800

200 Saint Clair Ave
Saint Marys, OH 45885-2400
Phone 41939433353569

2142 N Cove Blvd
Toledo, OH 43606-3895
Phone (419) 291-4000

718 N Macomb St
Monroe, MI 48162-7815
Phone (734) 240-8400

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
99.25 of 100Reported as group
Quality
96.55
Improvement activities
40
Cost
89.76

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
5101020914MIMDEmergency Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Joint Township District Memorial Hospital CurrentSince Jul 22, 2023 Accepting new patients
Observation Physicians of Northwest Ohio LLC Emergency Medicine CurrentSince Jul 3, 2022 Accepting new patients
The Toledo Hospital CurrentSince Apr 1, 2024 Accepting new patients
The Toledo Hospital CurrentSince Apr 1, 2024 Accepting new patients
Emergency Physicians of Northwest Ohio Inc. Emergency Medicine CurrentSince Jul 3, 2022 Accepting new patients
Haematology-Oncology Associates of Ohio and Michigan PC Current Accepting new patients
Consultants in Laboratory Medicine of Greater Toledo Current Accepting new patients
JTDM Family Practice LLC Past Accepting new patients
Lima Memorial Joint Operating Company Past Accepting new patients

Locations

718 N Macomb St
Monroe, MI 48162
Phone (734) 212-3097

1001 Bellefontaine Ave
Lima, OH 45804
Phone (419) 228-3335

1075 Medical Center Pkwy
Maumee, OH 43537
Phone (567) 585-0800

200 Saint Clair Ave
Saint Marys, OH 45885
Phone (419) 394-3387

2142 N Cove Blvd
Toledo, OH 43606
Phone (419) 291-1111

Organizations & group practices 9

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 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": "1393891200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1709164800000",
    "number": "1487079190",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2333 BIDDLE AVE",
            "city": "WYANDOTTE",
            "state": "MI",
            "postal_code": "481924668",
            "telephone_number": "734-287-9029"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2333 BIDDLE AVE",
            "city": "WYANDOTTE",
            "state": "MI",
            "postal_code": "481924668",
            "telephone_number": "734-287-9029"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PARK",
        "first_name": "JESSE",
        "middle_name": "AARON",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2014-03-04",
        "last_updated": "2024-02-29",
        "certification_date": "2022-06-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "MI",
            "license": "5101020914",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Wyandotte, MI

Sources for this page

Verify at the official NPI Registry.