NPIMap

Individual provider Active NPI

John Yung Park, D.O.

  • Hospitalist Physician
  • Ardmore, OK
National Provider Identifier
1811255268
Registry record updated May 10, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Hospitalist PhysicianTaxonomy code 208M00000X
License
81127 Issued in WI
Practice address
1011 14TH Ave NW
Ardmore, OK 73401-1828
Phone
(580) 220-6132
NPI assigned
Apr 23, 2012
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 10, 2023

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

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
Hospitalist Physician 208M00000X 5790 OK
Student in an Organized Health Care Education/Training Program 390200000X
Hospitalist Physician 208M00000X 81127 WI Primary
Internal Medicine Physician 207R00000X 5790 OK

Addresses

Primary practice location

1011 14TH Ave NW
Ardmore, OK 73401-1828

Mailing address

3 Neenah Ctr
Neenah, WI 54956-3070
Phone (920) 731-4101

Other practice location 1

1818 N Meade St
Appleton, WI 54911-3454
Phone (920) 731-4101

Other practice location 2

130 2nd St
Neenah, WI 54956-2883
Phone (920) 729-2155

Other practice location 3

1405 Mill St
New London, WI 54961-2155
Phone (920) 531-2000

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OK, WI2 enrollments
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20150916003114 OK Practitioner - Internal Medicine 7416264866 Reassigns benefits to 1 organization
I20230522002811 WI Practitioner - Hospitalist 7416264866 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Hospitalist
Education
New York College of Osteo Medicine of New York Institute of Technology, 2012
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Thedacare, IncorporatedGroup PAC ID 1759294887, 654 clinicians

Practice addresses (Care Compare)

1818 N Meade St
Appleton, WI 54911-3454
Phone (920) 735-7645

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
81127WIMDHospitalist Physician
5790OKMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Thedacare, Incorporated CurrentSince Jun 1, 2023 Accepting new patients
Thedacare, Incorporated CurrentSince Jun 1, 2023 Accepting new patients
Mercy Clinic Oklahoma Communities Internal Medicine CurrentSince Aug 10, 2015 Accepting new patients

Locations

530 N Monte Vista St
Ste A
Ada, OK 74820
Phone (580) 310-9510

1011 14th Ave NW
Ardmore, OK 73401
Phone (580) 220-6658

4300 W Memorial Rd
Oklahoma City, OK 73120
Phone (405) 752-3962

4300 McAuley Blvd
Oklahoma City, OK 73120
Phone (405) 936-5455

1818 N Meade St
Appleton, WI 54911
Phone (920) 731-4101

4480 W Spencer St
Appleton, WI 54914
Phone (920) 738-4800

130 2nd St
Neenah, WI 54956
Phone (920) 729-2063

3 Neenah Ctr
Neenah, WI 54956
Phone (920) 454-4229

1405 Mill St
New London, WI 54961
Phone (920) 531-2000

600 N Westhaven Dr
Oshkosh, WI 54904
Phone (920) 237-5000

Interoperability endpoints

  • Direct secure messaging: jpark331309@direct.thedacare.org
  • Direct secure messaging: jpark712994@directa.mercy.net

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 19

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

View all 19

NPI Registry JSON

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

{
    "created_epoch": "1335139200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1683676800000",
    "number": "1811255268",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3 NEENAH CTR",
            "city": "NEENAH",
            "state": "WI",
            "postal_code": "549563070",
            "telephone_number": "920-731-4101",
            "fax_number": "920-735-7618"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1011 14TH AVE NW",
            "city": "ARDMORE",
            "state": "OK",
            "postal_code": "734011828",
            "telephone_number": "580-220-6132"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1818 N Meade St",
            "address_purpose": "LOCATION",
            "city": "Appleton",
            "state": "WI",
            "postal_code": "549113454",
            "country_code": "US",
            "telephone_number": "920-731-4101",
            "fax_number": "920-735-7618",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "130 2nd St",
            "address_purpose": "LOCATION",
            "city": "Neenah",
            "state": "WI",
            "postal_code": "549562883",
            "country_code": "US",
            "telephone_number": "920-729-2155",
            "fax_number": "920-729-3167",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1405 Mill St",
            "address_purpose": "LOCATION",
            "city": "New London",
            "state": "WI",
            "postal_code": "549612155",
            "country_code": "US",
            "telephone_number": "920-531-2000",
            "fax_number": "920-531-2098",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "PARK",
        "first_name": "JOHN",
        "middle_name": "YUNG",
        "credential": "D.O.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2012-04-23",
        "last_updated": "2023-05-10",
        "certification_date": "2023-05-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208M00000X",
            "taxonomy_group": "",
            "desc": "Hospitalist",
            "state": "OK",
            "license": "5790",
            "primary": false
        },
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "208M00000X",
            "taxonomy_group": "",
            "desc": "Hospitalist",
            "state": "WI",
            "license": "81127",
            "primary": true
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "OK",
            "license": "5790",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Ardmore, OK

Sources for this page

Verify at the official NPI Registry.