NPIMap

Individual provider Active NPI

Samuel Wan Park, MD

  • Orthopaedic Surgery Physician
  • Mission Viejo, CA
National Provider Identifier
1710181854
Registry record updated Feb 17, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Orthopaedic Surgery PhysicianTaxonomy code 207X00000X
License
A96320 Issued in CA
Practice address
26730 Crown Valley Pkwy
Suite 200
Mission Viejo, CA 92691
Phone
(949) 364-2154
Fax
(949) 496-8872
NPI assigned
Jun 13, 2007
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 17, 2020

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Orthopaedic Surgery Physician 207X00000X A96320 CA Primary

Addresses

Primary practice location

26730 Crown Valley Pkwy
Suite 200
Mission Viejo, CA 92691

Mailing address

26730 Crown Valley Pkwy
Suite 200
Mission Viejo, CA 92691-6364
Phone (949) 364-2154

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA
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
I20111004000505 CA Practitioner - Orthopedic Surgery 8022201144 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Orthopedic Surgery
Education
University of Pittsburgh School of Medicine, 2004
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

26730 Crown Valley Pkwy
Suite 200
Mission Viejo, CA 92691-8001
Phone (714) 634-4567

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
75.34 of 100Reported as group
Quality
48.62
Promoting interoperability
94
Improvement activities
40
Cost
74.18

Procedures performed for Medicare patients

ProcedureNumber of procedures
Hip replacement90
Knee replacement155
Lower limb (leg) arthroscopy (minimally invasive joint repair)50
Removal of tissue1-10

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled
HHS exclusion list flag
CMS’s directory marks this NPI as on an HHS exclusion list; no matching OIG record was found. 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 Medicine

State licenses

LicenseStateTypeSpecialty
A96320CAMDOrthopaedic Surgery Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Orthopaedic Specialty Institute Medical Group of Orange County Orthopaedic Surgery CurrentSince Sep 1, 2023 Accepting new patients
Mission Hospital Regional Medical Center Past Accepting new patients
Brigham and Womens Physicians Organization Inc Past Accepting new patients

Locations

16300 Sand Canyon Ave
Ste 511
Irvine, CA 92618
Phone (949) 255-9890

26730 Crown Valley Pkwy
Mission Viejo, CA 92691
Phone (949) 364-2201

26730 Crown Valley Pkwy
Ste 200
Mission Viejo, CA 92691
Phone (949) 235-1508

280 S Main St
Ste 200
Orange, CA 92868
Phone (714) 937-2155

363 S Main St
Ste 220
Orange, CA 92868
Phone (714) 937-2193

Networks

  • BSC 65 PLUS INDIVIDUAL MAPD

Interoperability endpoints

  • Direct secure messaging: samuel.park.p1@direct.newportortho.nextgenshare.com
  • Direct secure messaging: samuel.parkmd.p1@direct.osiortho.nextgenshare.com
  • Direct secure messaging: samuel.park.p17@direct.newportmed.nextgenshare.com

Organizations & group practices 3

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 8

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": "1181692800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1581897600000",
    "number": "1710181854",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "26730 CROWN VALLEY PKWY",
            "address_2": "SUITE 200",
            "city": "MISSION VIEJO",
            "state": "CA",
            "postal_code": "926916364",
            "telephone_number": "949-364-2154",
            "fax_number": "949-496-8872"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "26730 CROWN VALLEY PKWY",
            "address_2": "SUITE 200",
            "city": "MISSION VIEJO",
            "state": "CA",
            "postal_code": "92691",
            "telephone_number": "949-364-2154",
            "fax_number": "949-496-8872"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PARK",
        "first_name": "SAMUEL",
        "middle_name": "WAN",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-06-13",
        "last_updated": "2020-02-17",
        "certification_date": "2020-02-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207X00000X",
            "taxonomy_group": "",
            "desc": "Orthopaedic Surgery",
            "state": "CA",
            "license": "A96320",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Mission Viejo, CA

Sources for this page

Verify at the official NPI Registry.