NPIMap

Individual provider Active NPI

Charles C Park, MD

  • Neurological Surgery Physician
  • Baltimore, MD
National Provider Identifier
1861438517
Registry record updated May 31, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Neurological Surgery PhysicianTaxonomy code 207T00000X
License
D0051977 Issued in MD
Practice address
301 St. Paul Place
Pob # 310
Baltimore, MD 21202
Phone
(410) 332-9872
Fax
(410) 659-1172
NPI assigned
Jun 21, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 31, 2016

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Neurological Surgery Physician 207T00000X D0051977 MD Primary

Addresses

Primary practice location

301 St. Paul Place
Pob # 310
Baltimore, MD 21202

Mailing address

301 St. Paul Place
Medical Staff Office
Baltimore, MD 21202-2102

Other identifiers 2

IdentifierTypeStateIssuer
388700600MedicaidMD
BU53/0001OtherMDCAREFIRST

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MD
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
I20070801000732 MD Practitioner - Neurosurgery 3577654755 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Neurosurgery
Education
Other, 1991
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Meritus Medical Center IncGroup PAC ID 7113811795, shared by 8 NPIs, 730 clinicians
Agape Physical Therapy and Sports Rehabilitation LPGroup PAC ID 3870741390, 684 clinicians
Amber Hill Physical Therapy IncGroup PAC ID 8527963917, 336 clinicians
Neurosurgical Specialty Services, LLCGroup PAC ID 0244543635, 7 clinicians
Lifebridge Sports Medicine and Rehabilitation LLCGroup PAC ID 4385787910, shared by 2 NPIs, 25 clinicians

Practice addresses (Care Compare)

11110 Medical Campus Rd
Hagerstown, MD 21742-6700

12 Newport Dr
Suite a
Forest Hill, MD 21050-1758

187 Thomas Johnson Dr
Suite 6
Frederick, MD 21702-4503

301 Saint Paul St
Baltimore, MD 21202-2102
Phone (410) 659-2963

519 Bayview Blvd
Baltimore, MD 21224-2825
Phone (443) 335-6910

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
67.53 of 100Reported as individual
Quality
0
Promoting interoperability
100
Improvement activities
40
Cost
83.07

Procedures performed for Medicare patients

ProcedureNumber of procedures
Spinal fusion507
Laminectomy or laminotomy (partial removal of spine bones)124

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Frederick Health Hospital Inc Past Accepting new patients
Mercy Medical Center Inc Past Accepting new patients

Interoperability endpoints

  • Direct secure messaging: cpark6091@direct.mdmercy.com

Organizations & group practices 5

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 6

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

NPI Registry JSON

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

{
    "created_epoch": "1150848000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1464652800000",
    "number": "1861438517",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "301 ST. PAUL PLACE",
            "address_2": "MEDICAL STAFF OFFICE",
            "city": "BALTIMORE",
            "state": "MD",
            "postal_code": "212022102"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "301 ST. PAUL PLACE",
            "address_2": "POB # 310",
            "city": "BALTIMORE",
            "state": "MD",
            "postal_code": "21202",
            "telephone_number": "410-332-9872",
            "fax_number": "410-659-1172"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PARK",
        "first_name": "CHARLES",
        "middle_name": "C",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-06-21",
        "last_updated": "2016-05-31",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207T00000X",
            "taxonomy_group": "",
            "desc": "Neurological Surgery",
            "state": "MD",
            "license": "D0051977",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "388700600",
            "state": "MD"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CAREFIRST",
            "identifier": "BU53/0001",
            "state": "MD"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Baltimore, MD

Sources for this page

Verify at the official NPI Registry.