NPIMap

Individual provider Active NPI

David J Park, M.D.

  • Family Medicine Physician
  • White River Junction, VT
National Provider Identifier
1790780211
Registry record updated Mar 29, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
042-0010755 Issued in VT
Practice address
331 Olcott Dr
Ste U3
White River Junction, VT 05001-9601
Phone
(802) 295-6132
Fax
(802) 295-1358
NPI assigned
Jun 21, 2005
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 29, 2021

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 042-0010755 VT Primary

Addresses

Primary practice location

331 Olcott Dr
Ste U3
White River Junction, VT 05001-9601

Mailing address

331 Olcott Dr
Ste U3
White River Junction, VT 05001-9601
Phone (802) 295-6132

Other identifiers 2

IdentifierTypeStateIssuer
1010649MedicaidVT
8000079MedicaidVT

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in VT
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
I20040804000092 VT Practitioner - Family Practice 7113998154 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Jefferson Medical College of Thomas Jefferson University, 2001
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
White River Family Practice PCGroup PAC ID 3971561358, 9 clinicians

Practice addresses (Care Compare)

331 Olcott Dr
Suite U3
White River Junction, VT 05001-9263
Phone (802) 295-6132

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Removal of nail tissue1-10
Removal or shaving of skin growth1-10
Skin biopsy1-10

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
042-0010755VTMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
White River Family Practice PC Family Medicine CurrentSince Jan 1, 2005 Accepting new patients
Dartmouth-Hitchcock Clinic PastSince Jan 1, 2005 Accepting new patients

Locations

331 Olcott Dr
Ste U3
White River Junction, VT 05001
Phone (802) 295-6132

331 Olcott Dr
Ste 3
White River Junction, VT 05001

Interoperability endpoints

  • Direct secure messaging: david.park@wrfp.eclinicaldirectplus.com

Organizations & group practices 2

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 17

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

View all 17

NPI Registry JSON

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

{
    "created_epoch": "1119312000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1616976000000",
    "number": "1790780211",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "331 OLCOTT DR",
            "address_2": "STE U3",
            "city": "WHITE RIVER JUNCTION",
            "state": "VT",
            "postal_code": "050019601",
            "telephone_number": "802-295-6132",
            "fax_number": "802-295-1358"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "331 OLCOTT DR",
            "address_2": "STE U3",
            "city": "WHITE RIVER JUNCTION",
            "state": "VT",
            "postal_code": "050019601",
            "telephone_number": "802-295-6132",
            "fax_number": "802-295-1358"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PARK",
        "first_name": "DAVID",
        "middle_name": "J",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-06-21",
        "last_updated": "2021-03-29",
        "certification_date": "2021-03-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "VT",
            "license": "042-0010755",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1010649",
            "state": "VT"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "8000079",
            "state": "VT"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in White River Junction, VT

Sources for this page

Verify at the official NPI Registry.