Individual provider Active NPI

Grace Park

  • Physical Medicine & Rehabilitation Physician
  • Whittier, CA
National Provider Identifier
1639707573
Registry record updated Jun 27, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical Medicine & Rehabilitation PhysicianTaxonomy code 208100000X
License
1639707573 Issued in CA
Practice address
12401 Washington Blvd
Whittier, CA 90602-1006
Phone
(562) 698-0811
NPI assigned
Mar 27, 2020
Last updated
Jun 27, 2024By the provider in NPPES
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jun 27, 2024

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Student in an Organized Health Care Education/Training Program 390200000X
Physical Medicine & Rehabilitation PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 208100000X 1639707573 CA Primary

Addresses

Primary practice location

12401 Washington Blvd
Whittier, CA 90602-1006

Mailing address

1912 S Jacaranda St Unit 417
Anaheim, CA 92805-8744
Phone (714) 401-3034

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA
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
I20240925003265 CA Practitioner - Physical Medicine and Rehabilitation 8325437148 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physical Medicine and Rehabilitation
Education
Other, 2020
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Pih Health PhysiciansGroup PAC ID 8426951328, 616 clinicians

Practice addresses (Care Compare)

12401 Washington Blvd
Whittier, CA 90602-1006
Phone (562) 698-0811

12462 Putnam St
Whittier, CA 90602-1049

12675 La Mirada Blvd
Suite 201And401
La Mirada, CA 90638-2200
Phone (562) 903-7339

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
78.61 of 100Reported as group
Quality
58.7
Improvement activities
40
Cost
75.08

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
19544CAMDGeneral Practice Dentistry
1639707573CAMDPhysical Medicine & Rehabilitation Physician

Practice roles

OrganizationSpecialtyStatusNew patients
GHP Medical Corporation Current Accepting new patients
Pih Health Physicians Single Specialty CurrentSince Sep 16, 2024 Accepting new patients
Pih Health Physicians CurrentSince Sep 16, 2024 Accepting new patients
Pih Health Physicians Single Specialty Current Accepting new patients
Bright Medical Associates, Inc. Single Specialty Past Accepting new patients

Locations

12675 La Mirada Blvd
Ste 201401
La Mirada, CA 90638
Phone (562) 903-7339

12401 Washington Blvd
Whittier, CA 90602
Phone (562) 698-0611

12462 Putnam St
Ste 402
Whittier, CA 90602
Phone (562) 789-5461

Networks

  • BSC 65 PLUS INDIVIDUAL MAPD

Interoperability endpoints

  • Direct secure messaging: gracepark@pihh.allscriptsdirect.net

Organizations & group practices 5

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 3

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": "1585267200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1719446400000",
    "number": "1639707573",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1912 S JACARANDA ST UNIT 417",
            "city": "ANAHEIM",
            "state": "CA",
            "postal_code": "928058744",
            "telephone_number": "714-401-3034"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12401 WASHINGTON BLVD",
            "city": "WHITTIER",
            "state": "CA",
            "postal_code": "906021006",
            "telephone_number": "562-698-0811"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PARK",
        "first_name": "GRACE",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2020-03-27",
        "last_updated": "2024-06-27",
        "certification_date": "2024-06-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "208100000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Physical Medicine & Rehabilitation",
            "state": "CA",
            "license": "1639707573",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Whittier, CA

Sources for this page

Verify at the official NPI Registry.