NPIMap

Individual provider Active NPI

Kyung Soon Park, MD

  • Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician
  • Clairton, PA
National Provider Identifier
1568454049
Registry record updated Oct 8, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Thoracic Surgery (Cardiothoracic Vascular Surgery) PhysicianTaxonomy code 208G00000X
License
MD-067920-L Issued in PA
Practice address
575 Coal Valley Road
Suite 504
Clairton, PA 15025-3729
Phone
(412) 469-7900
Fax
(412) 469-7919
NPI assigned
Aug 19, 2005
Last updated
Oct 8, 2020By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 8, 2020

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Specialist 174400000X MD067920L PA
Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician 208G00000X MD-067920-L PA Primary

Addresses

Primary practice location

575 Coal Valley Road
Suite 504
Clairton, PA 15025-3729

Mailing address

575 Coal Valley Road
Suite 504
Clairton, PA 15025-3729
Phone (412) 469-7900

Other identifiers 1

IdentifierTypeStateIssuer
0017467910002MedicaidPA

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address kpark73158@direct.ahn.org

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20100827000392 PA Practitioner - Thoracic Surgery 7012031024 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Thoracic Surgery
Education
Hahnemann University College of Medicine, 1992
Medicare assignment
May accept Medicare assignment
Telehealth
Offers telehealth services

Practice addresses (Care Compare)

575 Coal Valley Rd
Suite 504
Clairton, PA 15025-3729

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
93.9 of 100Reported as apm
Quality
85.02
Promoting interoperability
100
Improvement activities
40

Procedures performed for Medicare patients

ProcedureNumber of procedures
Coronary artery bypass graft (CABG)15
Leg revascularization (restoring blood flow)1-10

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
MD067920LPAMDSpecialist
MD-067920-LPAMDThoracic Surgery (Cardiothoracic Vascular Surgery) Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Park Cardiothoracic and Vascular Institute Thoracic Surgery (Cardiothoracic Vascular Surgery) CurrentSince Jul 1, 1999 Accepting new patients
Windber Hospital, Inc. Past Accepting new patients
Jefferson Regional Medical Center Past Accepting new patients

Locations

575 Coal Valley Rd
Ste 504
Jefferson Hls, PA 15025
Phone (412) 469-7900

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 11

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": "1124409600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1602115200000",
    "number": "1568454049",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "575 COAL VALLEY ROAD",
            "address_2": "SUITE 504",
            "city": "CLAIRTON",
            "state": "PA",
            "postal_code": "150253729",
            "telephone_number": "412-469-7900",
            "fax_number": "412-469-7919"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "575 COAL VALLEY ROAD",
            "address_2": "SUITE 504",
            "city": "CLAIRTON",
            "state": "PA",
            "postal_code": "150253729",
            "telephone_number": "412-469-7900",
            "fax_number": "412-469-7919"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PARK",
        "first_name": "KYUNG",
        "middle_name": "SOON",
        "name_prefix": "Mr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-08-19",
        "last_updated": "2020-10-08",
        "certification_date": "2020-10-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "",
            "desc": "Specialist",
            "state": "PA",
            "license": "MD067920L",
            "primary": false
        },
        {
            "code": "208G00000X",
            "taxonomy_group": "",
            "desc": "Thoracic Surgery (Cardiothoracic Vascular Surgery)",
            "state": "PA",
            "license": "MD-067920-L",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0017467910002",
            "state": "PA"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "kpark73158@direct.ahn.org",
            "affiliation": "N",
            "address_1": "575 Coal Valley Road",
            "address_2": "Suite 504",
            "city": "Clairton",
            "state": "PA",
            "country_code": "US",
            "postal_code": "150253729",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Clairton, PA

Sources for this page

Verify at the official NPI Registry.