NPIMap

Individual provider Active NPI

Christopher Lane Park, DO

  • Family Medicine Physician
  • Pontotoc, MS
National Provider Identifier
1710181078
Registry record updated May 5, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
19482 Issued in MS
Practice address
47 S Main St
Pontotoc, MS 38863-2823
Phone
(662) 499-2802
Fax
(866) 939-1560
NPI assigned
Jun 12, 2007
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 5, 2026

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 19482 MS Primary

Addresses

Primary practice location

47 S Main St
Pontotoc, MS 38863-2823

Mailing address

PO Box 507
Pontotoc, MS 38863-0507
Phone (662) 499-2802

Other practice location 1

1 Cvs Dr
Woonsocket, RI 02895-6146
Phone (866) 389-2727

Other identifiers 1

IdentifierTypeStateIssuer
06575065MedicaidMS

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MS
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
I20080414000516 MS Practitioner - Family Practice 1557448610 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Other, 2005
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Chris Park DO PCGroup PAC ID 6204258064, 2 clinicians

Practice addresses (Care Compare)

47 S Main St
Park Medical Clinic
Pontotoc, MS 38863-2823
Phone (662) 499-2802

Hospital & facility affiliations

  • Centerwell Home Health Home health agency, Tupelo, MS, CCN 257303
  • North Mississippi Medical Ctr HHA Home health agency, Tupelo, MS, CCN 257002
  • Baptist Home Care and Hospice North Mississippi Home health agency, Batesville, MS, CCN 257114
  • Baptist Memorial Hospital Union County Hospital, New Albany, MS, CCN 250006
  • Pontotoc Health Service Inc Cah Hospital, Pontotoc, MS, CCN 251308
  • North Mississippi Medical Center Hospital, Tupelo, MS, CCN 250004

Merit-based Incentive Payment System (MIPS)

Final score
98.55 of 100Reported as individual
Quality
99.93
Promoting interoperability
97
Improvement activities
40
Cost
81.18

Procedures performed for Medicare patients

ProcedureNumber of procedures
Removal of skin lesions1-10

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Redmed, LLC CurrentSince Jul 15, 2016 Accepting new patients
Lauderdale Medical Group PLLC CurrentSince Oct 22, 2023 Accepting new patients
Chris Park DO PC Family Medicine CurrentSince Jul 6, 2020 Accepting new patients
Redmed, LLC CurrentSince Jul 15, 2016 Accepting new patients
TC Medical of New Albany PC Family Medicine CurrentSince Jul 5, 2020 Accepting new patients

Locations

1250 E Commerce St
Hernando, MS 38632
Phone (662) 298-2238

12 Brookes Crossing
Pontotoc, MS 38863
Phone (662) 489-4044

47 S Main St
Pontotoc, MS 38863
Phone (662) 499-2802

11 E Jefferson St
Pontotoc, MS 38863
Phone (662) 419-1260

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 and National Provider Directory roles.

Hospital & facility affiliations 6

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": "1181606400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1777939200000",
    "number": "1710181078",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 507",
            "city": "PONTOTOC",
            "state": "MS",
            "postal_code": "388630507",
            "telephone_number": "662-499-2802",
            "fax_number": "866-939-1560"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "47 S MAIN ST",
            "city": "PONTOTOC",
            "state": "MS",
            "postal_code": "388632823",
            "telephone_number": "662-499-2802",
            "fax_number": "866-939-1560"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1 Cvs Dr",
            "address_purpose": "LOCATION",
            "city": "Woonsocket",
            "state": "RI",
            "postal_code": "028956146",
            "country_code": "US",
            "telephone_number": "866-389-2727",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "PARK",
        "first_name": "CHRISTOPHER",
        "middle_name": "LANE",
        "credential": "DO",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-06-12",
        "last_updated": "2026-05-05",
        "certification_date": "2026-05-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "MS",
            "license": "19482",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "06575065",
            "state": "MS"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Pontotoc, MS

Sources for this page

Verify at the official NPI Registry.