Mary Park, MD

Primary specialty

Pediatrics PhysicianTaxonomy code 208000000X

License

71839 Issued in MN

Practice address

290 Main St NW
Elk River, MN 55330-1270

Phone

(855) 324-7843

NPI assigned

May 15, 2019

Sex

Female

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 MN

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

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: mpark477125@fairview.direct-ci.com

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.

• Fairview Clinics

  dba Fairview Clinics-Hiawatha

  • Primary Care Clinic/Center
  • Minneapolis, MN
  • NPI 1346432218

  Single Specialty

  Medicare reassignment NPD
• Fairview Health Services

  • Emergency Medicine Physician
  • Minneapolis, MN
  • NPI 1811077175
  Medicare reassignment
• Fairview Clinics

  dba M Health Fairview Walk In Clinic Mall of America

  • Clinic/Center
  • Bloomington, MN
  • NPI 1134773419
  NPD
• Fairview Clinics

  • Primary Care Clinic/Center
  • Saint Paul, MN
  • NPI 1396552147
  NPD
• Fairview Health Services

  dba Fairview Hospital University

  • General Acute Care Hospital
  • Minneapolis, MN
  • NPI 1013994359

  Single Specialty

  NPD
• Fairview Health Services

  dba Fairview Emergency Medical Services

  • Land Ambulance
  • Saint Paul, MN
  • NPI 1710212485
  NPD
• Fairview Health Services

  dba Fairview Northland Hospital

  • General Acute Care Hospital
  • Princeton, MN
  • NPI 1922085299

  Single Specialty

  NPD
• Fairview Clinics

  dba Fairview Clinics-Maple Grove

  • Multi-Specialty Clinic/Center
  • Maple Grove, MN
  • NPI 1841315165
  NPD (past)

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

{
    "created_epoch": "1557878400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1657152000000",
    "number": "1891351862",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "290 MAIN ST NW",
            "city": "ELK RIVER",
            "state": "MN",
            "postal_code": "553301270",
            "telephone_number": "855-324-7843"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "290 MAIN ST NW",
            "city": "ELK RIVER",
            "state": "MN",
            "postal_code": "553301270",
            "telephone_number": "855-324-7843"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2450 Riverside Ave Fl 6",
            "address_purpose": "LOCATION",
            "city": "Minneapolis",
            "state": "MN",
            "postal_code": "554541450",
            "country_code": "US",
            "telephone_number": "612-624-4477",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "PARK",
        "first_name": "MARY",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2019-05-15",
        "last_updated": "2022-07-07",
        "certification_date": "2022-05-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "208000000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Pediatrics",
            "state": "MN",
            "license": "71839",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Brooke Anne Orth
• Henry James Padgett, GNP
• Page Counseling Services
• Traci Page, MA LPCC LADC
• Kasey Marie Palmer
• Kinnari Patel, PHARM D
• Spencer Daniel Patten
• Kimberly Jane Paulson
• Sara Elizabeth Pauly
• Anna Payne, DC

• Pediatrics Physician in Elk River, MN
• Providers in Elk River, MN by specialty
• Pediatrics Physician in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 7, 2022; 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.