Edward Y Park, DO

Primary specialty

Nephrology PhysicianTaxonomy code 207RN0300X

License

4218 Issued in AZ

Practice address

2149 E Warner Rd Ste 102
Tempe, AZ 85284-3495

Phone

(480) 610-6100

Fax

(480) 464-0189

NPI assigned

Jun 30, 2006

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 4

Medicare fee-for-service enrollment

Enrolled in AZ

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

Specialty

NephrologyAlso: Internal Medicine

Education

At Still University of Health Sciences, College of Osteo Med, Kirksville, 2003

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Group practices

Southwest Kidney Institute PLCGroup PAC ID 8224930987, 100 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• DaVita Arrowhead Lakes Dialysis Center Dialysis facility, Glendale, AZ, CCN 032604
• DaVita Sweetwater Ridge Dialysis Dialysis facility, Peoria, AZ, CCN 032640
• Usrc Northeast Phoenix Dialysis facility, Phoenix, AZ, CCN 032596
• Banner Thunderbird Medical Center Hospital, Glendale, AZ, CCN 030089
• Honorhealth Deer Valley Medical Center Hospital, Phoenix, AZ, CCN 030092

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Osteopathy, Doctor of Medicine

Practice roles

Locations

Interoperability endpoints

• FHIR API: https://api.platform.athenahealth.com/2697/brand/1/csg/22/fhir/r4
• Direct secure messaging: edward.park.1@2697.direct.athenahealth.com

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.

• Southwest Kidney Institute, PLC

  • Nephrology Physician
  • Tempe, AZ
  • NPI 1659316008
  Medicare reassignment Care Compare group
• Southwest Kidney Institute Scottsdale LLC

  • Nephrology Physician
  • Phoenix, AZ
  • NPI 1902231012
  Medicare reassignment
• Southwest Kidney Institute, PLC

  • Nephrology Physician
  • Tucson, AZ
  • NPI 1407094436
  NPD
• Ipn of Arizona, PLC

  • Internal Medicine Physician
  • Glendale, AZ
  • NPI 1538119284
  NPD (past)

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

• Desert Rocks Dialysis LLC

  • End-Stage Renal Disease (ESRD) Treatment Clinic/Center
  • Peoria, AZ
  • NPI 1508100470

  Dialysis facility

  Care Compare affiliation Name & address match
• Dialysis Newco LLC

  • End-Stage Renal Disease (ESRD) Treatment Clinic/Center
  • Phoenix, AZ
  • NPI 1326321886

  Dialysis facility

  Care Compare affiliation Name & address match
• Southwest Kidney Davita Dialysis Partners LLC

  • End-Stage Renal Disease (ESRD) Treatment Clinic/Center
  • Glendale, AZ
  • NPI 1962685636

  Dialysis facility

  Care Compare affiliation Name & address match
• Banner Thunderbird Medical Center

  • General Acute Care Hospital
  • Glendale, AZ
  • NPI 1154355188
  Care Compare affiliation
• Honorhealth

  • General Acute Care Hospital
  • Phoenix, AZ
  • NPI 1528169125
  Care Compare affiliation

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

{
    "created_epoch": "1151625600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1484784000000",
    "number": "1497783971",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2149 E WARNER RD",
            "address_2": "SUITE 101",
            "city": "TEMPE",
            "state": "AZ",
            "postal_code": "852843494",
            "telephone_number": "480-610-6100",
            "fax_number": "480-464-0189"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2149 E WARNER RD STE 102",
            "city": "TEMPE",
            "state": "AZ",
            "postal_code": "852843495",
            "telephone_number": "480-610-6100",
            "fax_number": "480-464-0189"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PARK",
        "first_name": "EDWARD",
        "middle_name": "Y",
        "credential": "DO",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-06-30",
        "last_updated": "2017-01-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207RN0300X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Nephrology",
            "state": "AZ",
            "license": "4218",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ARIZONA STATE LICENSE",
            "identifier": "4218",
            "state": "AZ"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2675627",
            "state": "OH"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BC/BS OF OHIO",
            "identifier": "000000483998",
            "state": "OH"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "182405",
            "state": "AZ"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Sara Noel Paquet, MD
• Paragon Citadel LLC
• Paramount Recovery Center LLC
• Parent Information Distribution Center, Inc
• Rajiv Parikh, M.D.
• Jiyoo Park, PHARMD
• Won-Woo Park, D.M.D., M.S.
• Cynthia Ann Parke, REGISTERED NURSE
• Catharine Parker, PA-C
• Leroy Parker IV, PA

• Nephrology Physician in Tempe, AZ
• Providers in Tempe, AZ by specialty
• Nephrology Physician in Arizona

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 19, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.