NPIMap

Individual provider Active NPI

Andrew Eunkoo Park, M.D.

  • Orthopaedic Surgery of the Spine Physician
  • Addison, TX
National Provider Identifier
1598722654
Registry record updated Jun 15, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Orthopaedic Surgery of the Spine PhysicianTaxonomy code 207XS0117X
License
L6562 Issued in TX
Practice address
17051 Dallas Pkwy
Suite 400
Addison, TX 75001-7109
Phone
(214) 370-3006
Fax
(214) 828-1379
NPI assigned
May 1, 2006
Last updated
Jun 15, 2022By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 15, 2022

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Orthopaedic Surgery of the Spine Physician 207XS0117X L6562 TX Primary

Addresses

Primary practice location

17051 Dallas Pkwy
Suite 400
Addison, TX 75001-7109

Mailing address

17051 Dallas Pkwy
Suite 400
Addison, TX 75001-7109
Phone (214) 370-3535

Other identifiers 5

IdentifierTypeStateIssuer
8810M3OtherTXBLUE CROSS PIN
00954841AMedicaidTX
159521702MedicaidTX
159521701MedicaidTX
P00714233OtherTXRAIL ROAD MEDICARE PIN

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TX
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
I20090206000516 TX Practitioner - Orthopedic Surgery 8729027057 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Orthopedic Surgery
Education
Northwestern University Feinberg Medical School, 1997
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Texas Spine Consultants, LLPGroup PAC ID 5890850804, 14 clinicians

Practice addresses (Care Compare)

17051 Dallas Pkwy
Suite 400
Addison, TX 75001-7108
Phone (214) 370-3535

5757 Warren Pkwy
Pob 11 Suite 180
Frisco, TX 75034-4274
Phone (214) 370-3535

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
75 of 100Reported as group

Procedures performed for Medicare patients

ProcedureNumber of procedures
Spinal fusion297
Laminectomy or laminotomy (partial removal of spine bones)88

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Texas Premium Medical LLC Orthopaedic Surgery of the Spine Current Accepting new patients
TSC Anesthesia PLLC CurrentSince Aug 1, 2019 Accepting new patients
North Texas Spinecare, LLP Orthopaedic Surgery of the Spine Past Accepting new patients
Summit Medical Center Past Accepting new patients
Texas Spine Consultants, LLP Orthopaedic Surgery of the Spine Past Accepting new patients

Locations

17051 Dallas Pkwy
Ste 400
Addison, TX 75001
Phone (469) 243-9390

Interoperability endpoints

  • Direct secure messaging: andrew.park.1@15749.direct.athenahealth.com
  • Direct secure messaging: apark@direct.uspi.com

Organizations & group practices 7

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": "1146441600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1655251200000",
    "number": "1598722654",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "17051 DALLAS PKWY",
            "address_2": "SUITE 400",
            "city": "ADDISON",
            "state": "TX",
            "postal_code": "750017109",
            "telephone_number": "214-370-3535",
            "fax_number": "214-370-0004"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "17051 DALLAS PKWY",
            "address_2": "SUITE 400",
            "city": "ADDISON",
            "state": "TX",
            "postal_code": "750017109",
            "telephone_number": "214-370-3006",
            "fax_number": "214-828-1379"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PARK",
        "first_name": "ANDREW",
        "middle_name": "EUNKOO",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-05-01",
        "last_updated": "2022-06-15",
        "certification_date": "2022-06-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207XS0117X",
            "taxonomy_group": "",
            "desc": "Orthopaedic Surgery, Orthopaedic Surgery of the Spine",
            "state": "TX",
            "license": "L6562",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS PIN",
            "identifier": "8810M3",
            "state": "TX"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00954841A",
            "state": "TX"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "159521702",
            "state": "TX"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "159521701",
            "state": "TX"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAIL ROAD MEDICARE PIN",
            "identifier": "P00714233",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Addison, TX

Sources for this page

Verify at the official NPI Registry.