Individual provider Active NPI

Earl P Park, DMD MD

  • Oral & Maxillofacial Surgery (D.M.D.)
  • Birmingham, AL
National Provider Identifier
1558659698
Registry record updated Jul 21, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Oral & Maxillofacial Surgery (D.M.D.)Taxonomy code 204E00000X
License
35601 Issued in AL
Practice address
2000 6TH Ave S
Birmingham, AL 35233-2110
Phone
(205) 934-9999
NPI assigned
Jul 11, 2011
Last updated
Jul 21, 2022By the provider in NPPES
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jul 21, 2022

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Oral and Maxillofacial Surgery (Dentist) 1223S0112X RESTRICTED LA
Oral & Maxillofacial Surgery (D.M.D.) 204E00000X 35601 AL Primary

Addresses

Primary practice location

2000 6TH Ave S
Birmingham, AL 35233-2110

Mailing address

PO Box 55310
Birmingham, AL 35255-5310
Phone (205) 731-9701

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in LA
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
I20191008002365 LA Practitioner - Maxillofacial Surgery 0941582878 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Maxillofacial Surgery
Education
Other, 2014
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

1100 Florida Ave
FL 2
New Orleans, LA 70119-2715
Phone (985) 889-9893

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
94.21 of 100Reported as group
Quality
81.06
Promoting interoperability
100
Improvement activities
40
Cost
71.94

Procedures performed for Medicare patients

ProcedureNumber of procedures
Melanoma (skin cancer) excision1-10
Removal of tissue1-10

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
RESTRICTEDLAMDOral and Maxillofacial Surgery (Dentist)

Practice roles

OrganizationSpecialtyStatusNew patients
Louisiana State University School of Medicine in New Orleans Faculty G Current Accepting new patients
Louisiana State University School of Medicine in New Orleans Faculty G CurrentSince Aug 13, 2019 Accepting new patients
Louisiana State University School of Medicine in New Orleans Faculty G CurrentSince Aug 13, 2019 Accepting new patients
Touro Infirmary Past Accepting new patients

Locations

478 S Johnson St
New Orleans, LA 70112
Phone (504) 412-1000

1100 Florida Ave
Fl 2
New Orleans, LA 70119
Phone (504) 610-9314

1542 Tulane Ave
New Orleans, LA 70112
Phone (504) 866-2741

2000 Canal St
New Orleans, LA 70112
Phone (504) 702-2287

2832 Burdette St
New Orleans, LA 70125
Phone (504) 866-2741

Organizations & group practices 4

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 8

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": "1310342400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1658361600000",
    "number": "1558659698",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 55310",
            "city": "BIRMINGHAM",
            "state": "AL",
            "postal_code": "352555310",
            "telephone_number": "205-731-9701"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2000 6TH AVE S",
            "city": "BIRMINGHAM",
            "state": "AL",
            "postal_code": "352332110",
            "telephone_number": "205-934-9999"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PARK",
        "first_name": "EARL",
        "middle_name": "P",
        "name_prefix": "Dr.",
        "credential": "DMD MD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2011-07-11",
        "last_updated": "2022-07-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223S0112X",
            "taxonomy_group": "",
            "desc": "Dentist, Oral and Maxillofacial Surgery",
            "state": "LA",
            "license": "RESTRICTED",
            "primary": false
        },
        {
            "code": "204E00000X",
            "taxonomy_group": "",
            "desc": "Oral & Maxillofacial Surgery",
            "state": "AL",
            "license": "35601",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Birmingham, AL

Sources for this page

Verify at the official NPI Registry.