Individual provider Active NPI

Sung Ok Jeon, MD

  • Neurocritical Care Physician
  • Denver, CO
National Provider Identifier
1669979654
Registry record updated Nov 22, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Neurocritical Care PhysicianTaxonomy code 2084A2900X
License
DR0065381 Issued in CO
Practice address
777 Bannock St
Denver, CO 80204-4597
Phone
(303) 436-4949
Fax
(303) 602-6190
NPI assigned
Apr 7, 2018
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 22, 2024

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

Specialties & licenses 5

Specialty (taxonomy)CodeLicenseStatePrimary
Neurology Physician 2084N0400X MD221747 OR
Neurology Physician 2084N0400X ME163265 FL
Neurology Physician 2084N0400X MD61575667 WA
Student in an Organized Health Care Education/Training Program 390200000X
Neurocritical Care Physician 2084A2900X DR0065381 CO Primary

Addresses

Primary practice location

777 Bannock St
Denver, CO 80204-4597

Mailing address

777 Bannock St
Denver, CO 80204-4597
Phone (303) 436-4949

Other practice location 1

11215 Metro Pkwy Ste 1
Fort Myers, FL 33966-1206
Phone (239) 208-2212

Other practice location 2

2801 N Gantenbein Ave
Portland, OR 97227-1623
Phone (503) 413-2200

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in SC, FL, CO, OR4 enrollments
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 4

Enrollment IDStateProvider typePAC IDDetails
I20231017001195 SC Practitioner - Neurology 9537415633 Reassigns benefits to 4 organizations
I20231019000984 FL Practitioner - Neurology 9537415633 Reassigns benefits to 3 organizations
I20240717004566 CO Practitioner - Neurology 9537415633 Reassigns benefits to 1 organization
I20241121002338 OR Practitioner - Neurology 9537415633 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Neurology
Education
University of Rochester School of Medicine and Dentistry, 2018
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

777 Bannock St
Denver, CO 80204-4507
Phone (303) 436-6000

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
DR0065381COMDNeurocritical Care Physician
ME163265FLMDNeurology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
McLeod Health Clarendon CurrentSince Sep 18, 2023 Accepting new patients
Silverton Health CurrentSince Jan 23, 2025 Accepting new patients
Concord Hospital-Franklin Current Accepting new patients
Lee Memorial Health System CurrentSince Jan 5, 2024 Accepting new patients
Lee Health System Inc CurrentSince Oct 1, 2024 Accepting new patients
Lee Memorial Health System CurrentSince Jan 5, 2024 Accepting new patients
Landmark Hospital of Southwest Florida, LLC CurrentSince Oct 11, 2023 Accepting new patients
Lee Health System Inc CurrentSince Oct 1, 2024 Accepting new patients
McLeod Medical Center-Dillon CurrentSince Sep 18, 2023 Accepting new patients
McLeod Health Clarendon CurrentSince Sep 18, 2023 Accepting new patients
Silverton Health CurrentSince Jan 23, 2025 Accepting new patients
McLeod Health Cheraw CurrentSince Sep 18, 2023 Accepting new patients
Legacy Clinics LLC CurrentSince Nov 19, 2024 Accepting new patients
Nchmd Inc Current Accepting new patients
McLeod Medical Center-Dillon CurrentSince Sep 18, 2023 Accepting new patients
McLeod Loris Seacoast Hospital CurrentSince Sep 18, 2023 Accepting new patients
McLeod Health Cheraw CurrentSince Sep 18, 2023 Accepting new patients
Denver Health and Hospital Authority CurrentSince Sep 2, 2024 Accepting new patients
Nchmd, Inc CurrentSince Oct 11, 2023 Accepting new patients
Silverton Health Current Accepting new patients
McLeod Loris Seacoast Hospital CurrentSince Sep 18, 2023 Accepting new patients
Denver Health and Hospital Authority CurrentSince Sep 2, 2024 Accepting new patients
Denver Health and Hospital Authority Past Accepting new patients
Cep America - Neurology PC Neurology Past Accepting new patients

Locations

777 Bannock St
#1923
Denver, CO 80204
Phone (303) 602-2720

777 Bannock St
Denver, CO 80204

777 Bannock St
Ste MC3450
Denver, CO 80204

1138 Country Club Blvd
Cape Coral, FL 33990
Phone (239) 424-1900

8931 Colonial Center Dr
Ste 401
Fort Myers, FL 33905
Phone (239) 424-2030

2776 Cleveland Ave
Fort Myers, FL 33901
Phone (239) 343-2000

11215 Metro Pkwy
Ste 1
Fort Myers, FL 33966
Phone (239) 208-2206

930 S Main St
Ste C
Labelle, FL 33935
Phone (239) 674-5520

350 7th St N
Naples, FL 34102
Phone (239) 436-5000

680 2nd Ave N
Ste 304
Naples, FL 34102
Phone (239) 261-7711

250 Pleasant St
Concord, NH 03301
Phone (603) 225-2711

15 Aiken Ave
Franklin, NH 03235
Phone (603) 934-2060

1015 NW 22nd Ave
Portland, OR 97210
Phone (503) 413-7582

1919 NW Lovejoy St
Portland, OR 97209
Phone (503) 415-5600

2801 N Gantenbein Ave
Portland, OR 97227
Phone (503) 413-2200

1130 NW 22nd Ave
Ste 220
Portland, OR 97210
Phone (503) 413-4134

347 Fairview St
Silverton, OR 97381
Phone (503) 873-5667

342 Fairview St
Silverton, OR 97381
Phone (503) 525-7660

711 Chesterfield Hwy
Cheraw, SC 29520
Phone (843) 320-3304

301 E Jackson St
Dillon, SC 29536
Phone (843) 774-1166

555 E Cheves St
Florence, SC 29506
Phone (843) 662-5233

3655 Mitchell St
Loris, SC 29569
Phone (843) 716-7000

10 E Hospital St
Manning, SC 29102
Phone (803) 433-3000

Interoperability endpoints

  • Direct secure messaging: sjeon143473@direct.dhha.org

Organizations & group practices 24

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.

View all 24

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": "1523059200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1732233600000",
    "number": "1669979654",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "777 BANNOCK ST",
            "city": "DENVER",
            "state": "CO",
            "postal_code": "802044597",
            "telephone_number": "303-436-4949",
            "fax_number": "303-602-6190"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "777 BANNOCK ST",
            "city": "DENVER",
            "state": "CO",
            "postal_code": "802044597",
            "telephone_number": "303-436-4949",
            "fax_number": "303-602-6190"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "11215 Metro Pkwy Ste 1",
            "address_purpose": "LOCATION",
            "city": "Fort Myers",
            "state": "FL",
            "postal_code": "339661206",
            "country_code": "US",
            "telephone_number": "239-208-2212",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "2801 N Gantenbein Ave",
            "address_purpose": "LOCATION",
            "city": "Portland",
            "state": "OR",
            "postal_code": "972271623",
            "country_code": "US",
            "telephone_number": "503-413-2200",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "JEON",
        "first_name": "SUNG",
        "middle_name": "OK",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2018-04-07",
        "last_updated": "2024-11-22",
        "certification_date": "2024-11-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2084N0400X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Neurology",
            "state": "OR",
            "license": "MD221747",
            "primary": false
        },
        {
            "code": "2084N0400X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Neurology",
            "state": "FL",
            "license": "ME163265",
            "primary": false
        },
        {
            "code": "2084N0400X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Neurology",
            "state": "WA",
            "license": "MD61575667",
            "primary": false
        },
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "2084A2900X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Neurocritical Care",
            "state": "CO",
            "license": "DR0065381",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Denver, CO

Sources for this page

Verify at the official NPI Registry.