Samuel K. Park, M.D.

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

A050474 Issued in CA

Practice address

20072 SW Birch St Ste 100
Newport Beach, CA 92660-0794

Phone

(949) 757-1150

Fax

(949) 757-1170

NPI assigned

Nov 1, 2006

Last updated

Jul 8, 2007By the provider in NPPES

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in CA, IA2 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

Specialty

Family Practice

Education

Other, 1988

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Avera McKennanGroup PAC ID 0345157103, 957 clinicians

Osceola Community Hospital IncGroup PAC ID 5799692372, 13 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Osceola Community Hospital Hospital, Sibley, IA, CCN 161345
• Osceola Community Hospital Nursing home, CCN 16Z345

Procedures performed for Medicare patients

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: samuel.park@avera.sdhealthlink.net

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.

• Optimum Medical Clinics Inc

  • Family Medicine Physician
  • Newport Beach, CA
  • NPI 1649354366
  Medicare reassignment NPD Authorized official
• Avera McKennan

  dba Avera Medical Group Womens Health Specialists Sioux Falls

  • Obstetrics & Gynecology Physician
  • Sioux Falls, SD
  • NPI 1336111962

  IA

  Medicare reassignment Care Compare group NPD
• Osceola Community Hospital Inc.

  dba Osceola Regional Health Center

  • Critical Access Hospital
  • Sibley, IA
  • NPI 1780751222
  Medicare reassignment Care Compare group NPD
• Optimum Medical Clinics, Inc

  • Non-Pharmacy Dispensing Site
  • Newport Beach, CA
  • NPI 1043520885
  NPD (past) Authorized official
• Avera McKennan

  dba Avera Interventional Radiology

  • Diagnostic Radiology Physician
  • Sioux Falls, SD
  • NPI 1053680678
  NPD
• Avera McKennan

  dba Avera Medical Group Sibley

  • Family Medicine Physician
  • Sibley, IA
  • NPI 1417250762
  NPD
• Osceola Community Hospital Inc

  dba ORHC Specialty Clinic

  • Mental Health Counselor
  • Sibley, IA
  • NPI 1922746171
  NPD

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

• Osceola Community Hospital Inc

  dba Osceola Regional Health Center

  • Medicare Defined Swing Bed Hospital Unit
  • Sibley, IA
  • NPI 1861560609

  Nursing home

  Care Compare affiliation
• Osceola Community Hospital Inc.

  dba Osceola Regional Health Center

  • Critical Access Hospital
  • Sibley, IA
  • NPI 1780751222
  Care Compare affiliation

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

{
    "created_epoch": "1162339200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1497832661",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "20072 SW BIRCH ST STE 100",
            "city": "NEWPORT BEACH",
            "state": "CA",
            "postal_code": "926600794",
            "telephone_number": "949-757-1150",
            "fax_number": "949-757-1170"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "20072 SW BIRCH ST STE 100",
            "city": "NEWPORT BEACH",
            "state": "CA",
            "postal_code": "926600794",
            "telephone_number": "949-757-1150",
            "fax_number": "949-757-1170"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PARK",
        "first_name": "SAMUEL",
        "middle_name": "K.",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-11-01",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "CA",
            "license": "A050474",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "GR0088240",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Hannah Park
• Hayley Sang Bee Park
• James Park, D.O.
• Norela Vanessa Park, PHARMD
• One I Park
• William Park, M.D.
• Francesca Lynn Parker, PSY.D.
• Juliana Parker
• Tyson Caine Parker
• Parham Parto, M.D., M.P.H.

• Family Medicine Physician in Newport Beach, CA
• Providers in Newport Beach, CA by specialty
• Family Medicine Physician in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; 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.