NPIMap

Individual provider Active NPI

Timothy Park, M.D.

  • Surgery Physician
  • Charlotte, NC
National Provider Identifier
1932494655
Registry record updated Mar 19, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Surgery PhysicianTaxonomy code 208600000X
License
2021-00319 Issued in NC
Practice address
1000 Blythe Blvd
Charlotte, NC 28203-5812
Phone
(704) 355-2000
NPI assigned
Jun 9, 2011
Last updated
Mar 19, 2025By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 19, 2025

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Surgery Physician 208600000X 2021-00319 NC Primary

Addresses

Primary practice location

1000 Blythe Blvd
Charlotte, NC 28203-5812

Mailing address

2817 Rock Merritt Ave Stop a
Fort Bragg, NC 28310-0001

Other practice location 1

2817 Rock Merrit Ave Stop A
Fort Bragg, NC 28310-5812
Phone (910) 907-8922

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NC
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
I20210903001983 NC Practitioner - General Surgery 3173857430 Reassigns benefits to 4 organizations

Care Compare profile

Medicare Care Compare
Specialty
General Surgery
Education
Tulane University School of Medicine, 2011
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Carolinas Medical CenterGroup PAC ID 4789597477, 1,057 clinicians

Practice addresses (Care Compare)

1000 Blythe Blvd
Charlotte, NC 28203-5812
Phone (704) 355-2000

1350 S Kings Dr
Charlotte, NC 28207-2134
Phone (704) 355-7328

275 Hwy 16 N
Suite 202
Denver, NC 28037-3002
Phone (704) 732-9843

8800 N Tryon St
Charlotte, NC 28262-3300
Phone (704) 512-7000

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
100 of 100Reported as group
Promoting interoperability
99
Improvement activities
40

Merit-based Incentive Payment System (MIPS)

Final score
94 of 100Reported as apm
Quality
81.63
Promoting interoperability
100
Improvement activities
40

Procedures performed for Medicare patients

ProcedureNumber of procedures
Hernia repair - groin (open)1-10

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
2021-00319NCMDSurgery Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Carolinas Medical Center Current Accepting new patients
Carolinas Physicians Network Inc CurrentSince Aug 16, 2021 Accepting new patients
Carolinas Physicians Network Inc Current Accepting new patients
The Charlotte-Mecklenburg Hospital Authority CurrentSince Aug 16, 2021 Accepting new patients
Carolinas Physicians Network Inc General Practice CurrentSince Aug 16, 2021 Accepting new patients
The Charlotte-Mecklenburg Hospital Authority Current Accepting new patients
Carolinas Pathology Group, PA Current Accepting new patients
Carolinas Medical Center CurrentSince Aug 16, 2021 Accepting new patients
The Charlotte-Mecklenburg Hospital Authority CurrentSince Aug 16, 2021 Accepting new patients
Carolinas Medical Center CurrentSince Aug 16, 2021 Accepting new patients
Carolinas Medical Center-Northeast Past Accepting new patients
Carolinas Physicians Network, Inc Past Accepting new patients
Carolinas Medical Center General Practice Past Accepting new patients

Locations

1000 Blythe Blvd
Charlotte, NC 28203
Phone (704) 351-3791

14214 Ballantyne Lake Rd
Ste 100
Charlotte, NC 28277
Phone (704) 667-2650

200 Medical Park Dr
Ste 430
Concord, NC 28025
Phone (704) 403-5890

Interoperability endpoints

  • Direct secure messaging: tpark537572@carolinashealthcaresystem.direct-ci.com

Organizations & group practices 14

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

View all 14

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": "1307577600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1742342400000",
    "number": "1932494655",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2817 ROCK MERRITT AVE STOP A",
            "city": "FORT BRAGG",
            "state": "NC",
            "postal_code": "283100001"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1000 BLYTHE BLVD",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282035812",
            "telephone_number": "704-355-2000"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2817 Rock Merrit Ave Stop A",
            "address_purpose": "LOCATION",
            "city": "Fort Bragg",
            "state": "NC",
            "postal_code": "283105812",
            "country_code": "US",
            "telephone_number": "910-907-8922",
            "fax_number": "910-907-6069",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "PARK",
        "first_name": "TIMOTHY",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2011-06-09",
        "last_updated": "2025-03-19",
        "certification_date": "2025-03-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208600000X",
            "taxonomy_group": "",
            "desc": "Surgery",
            "state": "NC",
            "license": "2021-00319",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Charlotte, NC

Sources for this page

Verify at the official NPI Registry.