NPIMap

Individual provider Active NPI

Michael Jung Hoon Park, M.D.

  • Cardiovascular Disease Physician
  • Stony Brook, NY
National Provider Identifier
1760864037
Registry record updated Jun 12, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Cardiovascular Disease PhysicianTaxonomy code 207RC0000X
License
293472 Issued in NY
Practice address
101 Nicholls Road HSC T-16 Suite 030
Stony Brook, NY 11794-1126
Phone
(631) 638-4464
NPI assigned
Jun 23, 2015
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 12, 2023

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Student in an Organized Health Care Education/Training Program 390200000X
Internal Medicine Physician 207R00000X 293472 NY
Cardiovascular Disease Physician 207RC0000X 293472 NY Primary

Addresses

Primary practice location

101 Nicholls Road HSC T-16 Suite 030
Stony Brook, NY 11794-1126

Mailing address

23 Melbourne Rd
Great Neck, NY 11021-4636
Phone (917) 747-9090

Other practice location 1

100 High St
Buffalo, NY 14203-1126
Phone (716) 630-1000

Other practice location 2

1400 Pelham Pkwy S
Bronx, NY 10461-1138
Phone (718) 918-5000

Other practice location 3

1825 Eastchester Rd
Bronx, NY 10461
Phone (718) 904-2000

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NY
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
I20200708002750 NY Practitioner - Cardiovascular Disease (Cardiology)Practitioner - Internal Medicine 3678823879 Reassigns benefits to 5 organizations

Care Compare profile

Medicare Care Compare
Specialty
Cardiovascular Disease (Cardiology)
Education
Other, 2015
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
General Physician PCGroup PAC ID 9537213079, 488 clinicians

Practice addresses (Care Compare)

100 High St
Buffalo, NY 14203-1126
Phone (716) 859-1400

100 Nicolls Rd
Stony Brook, NY 11794-3407
Phone (631) 638-2121

101 Nicolls Rd
Stony Brook, NY 11794-0001
Phone (631) 444-5400

26 Research Way
East Setauket, NY 11733-3526
Phone (631) 444-0580

301 E Main St
Bay Shore, NY 11706-8408
Phone (631) 941-2000

Hospital & facility affiliations

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
General Physician, PC CurrentSince Oct 1, 2022 Accepting new patients
Mercy Hospital of Buffalo Hospitalist CurrentSince Jun 23, 2021 Accepting new patients
Mercy Hospital of Buffalo CurrentSince Jun 23, 2021 Accepting new patients
Stony Brook Internists, University Faculty Practice Corporation Cardiovascular Disease CurrentSince Aug 1, 2023 Accepting new patients
Stony Brook Radiology, University Faculty Practice Corporation CurrentSince Sep 1, 2023 Accepting new patients
Buffalo Medical Group, P.C. Internal Medicine CurrentSince Jun 15, 2020 Accepting new patients
Buffalo Medical Group, P.C. CurrentSince Jun 15, 2020 Accepting new patients
University Hospital at Stony Brook Past Accepting new patients

Locations

301 Montauk Hwy
Bay Shore, NY 11706
Phone (631) 630-3977

85 High St
Buffalo, NY 14203
Phone (716) 857-8623

100 High St
Buffalo, NY 14203
Phone (716) 632-3700

565 Abbott Rd
Buffalo, NY 14220
Phone (716) 826-7000

144 Genesee St
Fl 3
Buffalo, NY 14203
Phone (716) 601-3690

3898 Vineyard Dr
Dunkirk, NY 14048
Phone (716) 363-1515

26 Research Way
East Setauket, NY 11733
Phone (631) 444-0502

100 Nicolls Rd
Stony Brook, NY 11794
Phone (631) 444-1560

425 Essjay Rd
Ste 170
Williamsville, NY 14221
Phone (716) 630-1219

Networks

  • Healthfirst Medicare Network H5989
  • Healthfirst Medicare Network H3359
  • Healthfirst Medicare Network H9678
  • Healthfirst Medicare Network H1722

Interoperability endpoints

  • Direct secure messaging: mpark841195@nychhc.direct-ci.com

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 14

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

View all 14

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1435017600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1686528000000",
    "number": "1760864037",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "23 MELBOURNE RD",
            "city": "GREAT NECK",
            "state": "NY",
            "postal_code": "110214636",
            "telephone_number": "917-747-9090"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "101 NICHOLLS ROAD HSC T-16 SUITE 030",
            "city": "STONY BROOK",
            "state": "NY",
            "postal_code": "117941126",
            "telephone_number": "631-638-4464"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "100 High St",
            "address_purpose": "LOCATION",
            "city": "Buffalo",
            "state": "NY",
            "postal_code": "142031126",
            "country_code": "US",
            "telephone_number": "716-630-1000",
            "fax_number": "716-630-1348",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1400 Pelham Pkwy S",
            "address_purpose": "LOCATION",
            "city": "Bronx",
            "state": "NY",
            "postal_code": "104611138",
            "country_code": "US",
            "telephone_number": "718-918-5000",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1825 Eastchester Rd",
            "address_purpose": "LOCATION",
            "city": "Bronx",
            "state": "NY",
            "postal_code": "10461",
            "country_code": "US",
            "telephone_number": "718-904-2000",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "PARK",
        "first_name": "MICHAEL",
        "middle_name": "JUNG HOON",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2015-06-23",
        "last_updated": "2023-06-12",
        "certification_date": "2023-06-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "NY",
            "license": "293472",
            "primary": false
        },
        {
            "code": "207RC0000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Cardiovascular Disease",
            "state": "NY",
            "license": "293472",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Stony Brook, NY

Sources for this page

Verify at the official NPI Registry.