NPIMap

Individual provider Active NPI

Mary Park, MD

  • Obstetrics & Gynecology Physician
  • Port Angeles, WA
National Provider Identifier
1609161330
Registry record updated Oct 15, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Obstetrics & Gynecology PhysicianTaxonomy code 207V00000X
License
MD61579915 Issued in WA
Practice address
939 Caroline St # 3E
Port Angeles, WA 98362-3909
Phone
(360) 565-0599
Fax
(360) 452-7303
NPI assigned
Jun 10, 2011
Last updated
Oct 15, 2024By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 15, 2024

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Obstetrics & Gynecology Physician 207V00000X MD61579915 WA Primary
Obstetrics Physician 207VX0000X 280368 NY

Addresses

Primary practice location

939 Caroline St # 3E
Port Angeles, WA 98362-3909

Mailing address

PO Box 850
Port Angeles, WA 98362-0146

Other practice location 1

2900 E 136th Ave Ste 100
Thornton, CO 80241-3542
Phone (303) 999-3950

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CO, WA2 enrollments
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20211202002260 CO Practitioner - Obstetrics/Gynecology 8022321975 Reassigns benefits to 1 organization
I20240909004579 WA Practitioner - Obstetrics/Gynecology 8022321975 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Obstetrics/Gynecology
Education
Other, 2011
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Multicare Health SystemGroup PAC ID 7719899897, 2,312 clinicians

Practice addresses (Care Compare)

202 N Division St
Auburn, WA 98001-4939

222 State Ave N
Kent, WA 98030-4544
Phone (253) 372-7788

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Removal of the uterus1-10

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Multicare Health System CurrentSince Feb 24, 2025 Accepting new patients
Multicare Health System CurrentSince Feb 24, 2025 Accepting new patients
Multicare Health System Current Accepting new patients
Seasons for All Health Care CurrentSince Nov 20, 2022 Accepting new patients
Prowers County Hospital District CurrentSince Jul 10, 2024 Accepting new patients
Multicare Health System Past Accepting new patients
Multicare Health System Past Accepting new patients
Tanana Valley Clinic LLC Past Accepting new patients

Locations

401 Kendall Dr
Lamar, CO 81052
Phone (719) 336-4343

403 Kendall Dr
Lamar, CO 81052
Phone (719) 336-6767

2900 E 136th Ave
Ste 100
Thornton, CO 80241
Phone (303) 280-2229

4700 Point Fosdick Dr
Ste 104
Gig Harbor, WA 98335
Phone (253) 459-7590

222 State Ave N
Kent, WA 98030
Phone (253) 372-7680

Organizations & group practices 8

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 2

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": "1307664000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1728950400000",
    "number": "1609161330",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 850",
            "city": "PORT ANGELES",
            "state": "WA",
            "postal_code": "983620146"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "939 CAROLINE ST # 3E",
            "city": "PORT ANGELES",
            "state": "WA",
            "postal_code": "983623909",
            "telephone_number": "360-565-0599",
            "fax_number": "360-452-7303"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2900 E 136th Ave Ste 100",
            "address_purpose": "LOCATION",
            "city": "Thornton",
            "state": "CO",
            "postal_code": "802413542",
            "country_code": "US",
            "telephone_number": "303-999-3950",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "PARK",
        "first_name": "MARY",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2011-06-10",
        "last_updated": "2024-10-15",
        "certification_date": "2024-10-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207V00000X",
            "taxonomy_group": "",
            "desc": "Obstetrics & Gynecology",
            "state": "WA",
            "license": "MD61579915",
            "primary": true
        },
        {
            "code": "207VX0000X",
            "taxonomy_group": "",
            "desc": "Obstetrics & Gynecology, Obstetrics",
            "state": "NY",
            "license": "280368",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Port Angeles, WA

Sources for this page

Verify at the official NPI Registry.