Tina Park, M.D.

Primary specialty

Gastroenterology PhysicianTaxonomy code 207RG0100X

License

277511 Issued in NY

Practice address

622 W 168TH St
New York, NY 10032-3720

Phone

(212) 342-4776

NPI assigned

Jun 25, 2009

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in NY

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 1

Specialty

GastroenterologyAlso: Internal Medicine

Education

Other, 2009

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Group practices

Icahn School of Medicine at Mount SinaiGroup PAC ID 2264691070, 2,809 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Mount Sinai West Hospital, New York, NY, CCN 330046

Procedures performed for Medicare patients

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

Networks

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

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.

• Icahn School of Medicine at Mount Sinai

  • Gastroenterology Physician
  • New York, NY
  • NPI 1730440777
  Medicare reassignment Care Compare group NPD
• Icahn School of Medicine at Mount Sinai

  • Surgery Physician
  • New York, NY
  • NPI 1104295716
  Medicare reassignment NPD
• Icahn School of Medicine at Mount Sinai

  • Internal Medicine Physician
  • New York, NY
  • NPI 1568868834
  NPD
• Icahn School of Medicine at Mount Sinai

  • Eyewear Supplier
  • New York, NY
  • NPI 1760227466
  NPD
• Icahn School of Medicine at Mount Sinai

  • Obstetrics & Gynecology Physician
  • New York, NY
  • NPI 1124392212
  NPD (past)

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

• St Lukes Roosevelt Hospital Center

  • General Acute Care Hospital
  • New York, NY
  • NPI 1104982917
  Care Compare affiliation
• St. Lukes Roosevelt Hospital Center

  • Methadone Clinic
  • New York, NY
  • NPI 1609476357

  Hospital

  Care Compare affiliation

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

{
    "created_epoch": "1245888000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1556496000000",
    "number": "1821226101",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "630 W 168TH ST",
            "city": "NEW YORK",
            "state": "NY",
            "postal_code": "100323725",
            "telephone_number": "212-342-5155",
            "fax_number": "401-444-2947"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "622 W 168TH ST",
            "city": "NEW YORK",
            "state": "NY",
            "postal_code": "100323720",
            "telephone_number": "212-342-4776"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PARK",
        "first_name": "TINA",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2009-06-25",
        "last_updated": "2019-04-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "RI",
            "license": "LP01591",
            "primary": false
        },
        {
            "code": "207RG0100X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Gastroenterology",
            "state": "NY",
            "license": "277511",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NYS MED LICENSE",
            "identifier": "277511",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Susan Ahn Park, MD
• Susan S Park, DDS
• Susan Suh Young Park, M.D.
• Susie Park
• Thomas Park
• Tyler David Park, MD
• V Park, PHARM.D.
• Victoria Jeong Park, DDS
• Wungki Park, M.D.
• Yeon Su Park

• Gastroenterology Physician in New York, NY
• Providers in New York, NY by specialty
• Gastroenterology Physician in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 29, 2019; 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.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.