Individual provider Active NPI

Stephen Sangjin Park, M.D.

  • Emergency Medicine Physician
  • Dallas, TX
National Provider Identifier
1740627371
Registry record updated Apr 23, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Emergency Medicine PhysicianTaxonomy code 207P00000X
License
R7553 Issued in TX
Practice address
5200 Harry Hines Blvd
Dallas, TX 75235-7709
Phone
(214) 590-8000
NPI assigned
May 22, 2013
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 23, 2019

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Emergency Medicine Physician 207P00000X 01078028A IN
Emergency Medicine Physician 207P00000X R7553 TX Primary
Emergency Medicine Physician 207P00000X 036.142934 IL

Addresses

Primary practice location

5200 Harry Hines Blvd
Dallas, TX 75235-7709

Mailing address

6451 Brentwood Stair Rd Ste 200
Fort Worth, TX 76112-3200
Phone (330) 992-4770

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IL, TX2 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 2

Enrollment IDStateProvider typePAC IDDetails
I20170728000531 IL Practitioner - Emergency Medicine 6507162138 Reassigns benefits to 1 organization
I20181012001490 TX Practitioner - Emergency Medicine 6507162138 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Emergency Medicine
Education
Other, 2013
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Texas Medicine Resources, LLPGroup PAC ID 5890688212, 255 clinicians

Practice addresses (Care Compare)

6200 W Parker Rd
Plano, TX 75093-8185
Phone (972) 981-8000

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
036.142934ILMDEmergency Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
University of Texas Southwestern Medical Center at Dallas Current Accepting new patients
Advocate Health and Hospitals Corporation CurrentSince Jul 1, 2017 Accepting new patients
Century Integrated Partners, Inc Emergency Medicine CurrentSince Dec 1, 2018 Accepting new patients
Texas Medicine Resources, LLP Emergency Medicine CurrentSince Sep 1, 2019 Accepting new patients
Advocate Health & Hospitals Corporation CurrentSince Jul 1, 2017 Accepting new patients
University of Texas Southwestern Medical Center at Dallas Emergency Medicine CurrentSince Oct 1, 2018 Accepting new patients
Advocate Health and Hospitals Corporation Current Accepting new patients
The University of Texas Southwestern Medical Center at Dallas CurrentSince Oct 1, 2018 Accepting new patients

Locations

1325 N Highland Ave
Aurora, IL 60506
Phone (630) 801-2756

214 McHenry Rd
Buffalo Grove, IL 60089
Phone (847) 459-1160

29373 Network Pl
Chicago, IL 60673

2800 W 95th St
Evergreen Pk, IL 60805
Phone (708) 229-5104

1 Ingalls Dr
Harvey, IL 60426
Phone (708) 333-2300

1105 Central Expy N
Allen, TX 75013
Phone (972) 747-4313

8200 Walnut Hill Ln
Dallas, TX 75231
Phone (214) 345-6148

5201 Harry Hines Blvd
Dallas, TX 75235
Phone (214) 590-1396

3500 Gaston Ave
Dallas, TX 75246

1400 8th Ave
Ft Worth, TX 76104
Phone (817) 922-1559

6451 Brentwood Stair Rd
Ste 200
Ft Worth, TX 76112
Phone (817) 496-9700

1301 Pennsylvania Ave
Ft Worth, TX 76104
Phone (817) 250-2000

1901 N MacArthur Blvd
Irving, TX 75061
Phone (972) 484-5192

6200 W Parker Rd
Plano, TX 75093
Phone (972) 608-8000

4700 Alliance Blvd
#P
Plano, TX 75093
Phone (469) 814-2000

5323 Harry Hines Blvd
Ut Southwest Medical Center, TX 75390

Organizations & group practices 8

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 2

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": "1369180800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1555977600000",
    "number": "1740627371",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6451 BRENTWOOD STAIR RD STE 200",
            "city": "FORT WORTH",
            "state": "TX",
            "postal_code": "761123200",
            "telephone_number": "330-992-4770"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5200 HARRY HINES BLVD",
            "city": "DALLAS",
            "state": "TX",
            "postal_code": "752357709",
            "telephone_number": "214-590-8000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PARK",
        "first_name": "STEPHEN",
        "middle_name": "SANGJIN",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2013-05-22",
        "last_updated": "2019-04-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "IN",
            "license": "01078028A",
            "primary": false
        },
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "TX",
            "license": "R7553",
            "primary": true
        },
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "IL",
            "license": "036.142934",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Dallas, TX

Sources for this page

Verify at the official NPI Registry.