Nomin Park, NP

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

10026206 Issued in OR

Practice address

1003 E Main St Ste 104
Medford, OR 97504-7140

Phone

(541) 779-1282

NPI assigned

May 14, 2024

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in OR

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

State licenses

Practice roles

Locations

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.

• Onepeak Southern Oregon PC

  • Family Medicine Physician
  • Medford, OR
  • NPI 1740917558
  Medicare reassignment NPD
• Addictions Recovery Center, Inc.

  • Substance Abuse Rehabilitation Facility
  • Medford, OR
  • NPI 1346282035
  NPD

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

{
    "created_epoch": "1715644800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1728432000000",
    "number": "1801645742",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1003 E MAIN ST STE 104",
            "city": "MEDFORD",
            "state": "OR",
            "postal_code": "975047140",
            "telephone_number": "541-292-7639"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1003 E MAIN ST STE 104",
            "city": "MEDFORD",
            "state": "OR",
            "postal_code": "975047140",
            "telephone_number": "541-779-1282"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PARK",
        "first_name": "NOMIN",
        "credential": "NP",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2024-05-14",
        "last_updated": "2024-10-09",
        "certification_date": "2024-10-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "164W00000X",
            "taxonomy_group": "",
            "desc": "Licensed Practical Nurse",
            "state": "OR",
            "license": "10026206",
            "primary": false
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "OR",
            "license": "10026206",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Nicole Paradis, MSW/QMHP
• Charles Joseph Paradise, CRNA
• Aymeric F Parat, CADC I
• Brian Parcells
• Lindsey Rose Pariani
• Shannon Elaine Park, LCSW
• Emily Parker
• Jose James Parker, PA C
• Natalie Parker, LMT
• Ruthanne Parker

• Family Nurse Practitioner in Medford, OR
• Providers in Medford, OR by specialty
• Family Nurse Practitioner in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 9, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.