Jay Sung Park, D.O.

Primary specialty

Diagnostic Radiology PhysicianTaxonomy code 2085R0202X

License

OS11094 Issued in FL

Practice address

1600 Lakeland Hills Blvd
Lakeland, FL 33805-3019

Phone

(863) 680-7000

Fax

(866) 264-8519

NPI assigned

Oct 12, 2005

Sex

Male

Sole proprietor

No

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

Specialties & licenses 3

Addresses

Medicare fee-for-service enrollment

Enrolled in FL

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

Medicare enrollment (NPD)

Not enrolled

HHS exclusion list flag

Flagged The directory lists this NPI on an HHS exclusion list. The OIG exclusions file (LEIE) holds no record for this NPI, and the directory does not say which list the flag comes from. How exclusions are shown Confirm with the OIG exclusions search.

Credentials

Doctor of Osteopathy

State licenses

Practice roles

Locations

Networks

• Freedom Health HMO Network

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Millennium Physician Group LLC

  • Family Medicine Physician
  • Fort Myers, FL
  • NPI 1811122880
  Medicare reassignment NPD
• Baton Rouge Radiology Group Inc

  • Diagnostic Radiology Physician
  • Baton Rouge, LA
  • NPI 1407880339

  FL

  Medicare reassignment NPD
• North Oaks Medical Center, LLC

  • Diagnostic Radiology Physician
  • Hammond, LA
  • NPI 1164785648

  FL

  Medicare reassignment NPD
• Millennium Physician Group LLC

  • Family Medicine Physician
  • Brooksville, FL
  • NPI 1073131702
  NPD
• North Oaks Medical Center, LLC

  • General Acute Care Hospital
  • Hammond, LA
  • NPI 1972630705
  NPD
• Quality Medical Imaging of Arizona, Inc

  • Portable X-ray and/or Other Portable Diagnostic Imaging Supplier
  • Phoenix, AZ
  • NPI 1417124637
  NPD
• Quality Medical Imaging of Texas, Inc

  • Physiological Laboratory
  • San Antonio, TX
  • NPI 1699391862
  NPD
• Renaissance Radiology Associates PLLC

  • Diagnostic Radiology Physician
  • Edinburg, TX
  • NPI 1275181455
  NPD

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

{
    "created_epoch": "1129075200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1745798400000",
    "number": "1639167877",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1600 LAKELAND HILLS BLVD",
            "city": "LAKELAND",
            "state": "FL",
            "postal_code": "338053019",
            "telephone_number": "863-680-7000",
            "fax_number": "866-264-8519"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1600 LAKELAND HILLS BLVD",
            "city": "LAKELAND",
            "state": "FL",
            "postal_code": "338053019",
            "telephone_number": "863-680-7000",
            "fax_number": "866-264-8519"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "15790 Paul Vega Md Dr",
            "address_purpose": "LOCATION",
            "city": "Hammond",
            "state": "LA",
            "postal_code": "704031436",
            "country_code": "US",
            "telephone_number": "985-345-2700",
            "fax_number": "985-230-6652",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "PARK",
        "first_name": "JAY",
        "middle_name": "SUNG",
        "name_prefix": "Dr.",
        "credential": "D.O.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-10-12",
        "last_updated": "2025-04-28",
        "certification_date": "2025-04-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2085R0202X",
            "taxonomy_group": "",
            "desc": "Radiology, Diagnostic Radiology",
            "state": "LA",
            "license": "346214",
            "primary": false
        },
        {
            "code": "2085R0202X",
            "taxonomy_group": "",
            "desc": "Radiology, Diagnostic Radiology",
            "state": "OH",
            "license": "24.000017",
            "primary": false
        },
        {
            "code": "2085R0202X",
            "taxonomy_group": "",
            "desc": "Radiology, Diagnostic Radiology",
            "state": "FL",
            "license": "OS11094",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Andrew Parana, PT DPT
• Joseph Steven Paredes, DO, MPH
• Brenda Parejas, CMF
• Rebecca G Parish, RN
• Erin Gloria Park, DO
• Jong Ho Park, M.D., M.P.H
• Adam Corey Parker, D.O.
• Dane Vincent Parker, D.C., A.R.N.P.
• Jeanna Parker, ARNP
• Jeremy Adam Parker

• Diagnostic Radiology Physician in Lakeland, FL
• Providers in Lakeland, FL by specialty
• Diagnostic Radiology Physician in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 28, 2025; 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.