NPIMap

Individual provider Active NPI

Chan Jerome Park, MD, PHD

  • Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician
  • Las Vegas, NV
National Provider Identifier
1932498722
Registry record updated Oct 30, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Thoracic Surgery (Cardiothoracic Vascular Surgery) PhysicianTaxonomy code 208G00000X
License
20992 Issued in NV
Practice address
7190 S Cimarron Rd
Las Vegas, NV 89113-2171
Phone
(702) 675-3240
Fax
(702) 982-6347
NPI assigned
Mar 31, 2011
Last updated
Oct 30, 2024By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 30, 2024

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician 208G00000X 20992 NV Primary

Addresses

Primary practice location

7190 S Cimarron Rd
Las Vegas, NV 89113-2171

Mailing address

PO Box 33269
Phoenix, AZ 85067-3269
Phone (602) 406-4786

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NV
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
I20210525000936 NV Practitioner - Thoracic Surgery 4486949401 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Thoracic Surgery
Education
Harvard Medical School, 2001
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Dignity Health Medical Group Nevada LLCGroup PAC ID 1254571896, 127 clinicians

Practice addresses (Care Compare)

10001 S Eastern Ave
Suite 101
Henderson, NV 89052-3908
Phone (702) 616-5870

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
81.21 of 100Reported as group
Quality
63.87
Promoting interoperability
96
Improvement activities
40
Cost
76.83

Procedures performed for Medicare patients

ProcedureNumber of procedures
Coronary artery bypass graft (CABG)1-10
Upper gastrointestinal (GI) endoscopy for acid reflux1-10
Leg revascularization (restoring blood flow)1-10

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
20992NVMDThoracic Surgery (Cardiothoracic Vascular Surgery) Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Dignity Health Medical Group Nevada, LLC CurrentSince Apr 20, 2022 Accepting new patients
Dignity Health CurrentSince Jun 7, 2021 Accepting new patients
Dignity Health CurrentSince Jun 7, 2021 Accepting new patients
Dignity Health Past Accepting new patients
Dignity Health Past Accepting new patients
Dignity Health Past Accepting new patients
University Medical Center of Southern Nevada Past Accepting new patients
Sunrise Mountainview Hospital, Inc. Past Accepting new patients
Desert Springs Hospital Past Accepting new patients
Centennial Hills Hospital Medical Center Past Accepting new patients

Locations

10001 S Eastern Ave
Ste 101
Henderson, NV 89052
Phone (702) 614-0850

10001 S Eastern Ave
Ste 203
Henderson, NV 89052
Phone (702) 616-5915

2865 Siena Heights Dr
Ste 131
Henderson, NV 89052
Phone (702) 616-6580

8689 W Charleston Blvd
Ste 105
Las Vegas, NV 89117
Phone (702) 304-5900

7190 S Cimarron Rd
Las Vegas, NV 89113
Phone (702) 675-3240

Organizations & group practices 10

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.

Hospital & facility affiliations 3

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": "1301529600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1730246400000",
    "number": "1932498722",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 33269",
            "city": "PHOENIX",
            "state": "AZ",
            "postal_code": "850673269",
            "telephone_number": "602-406-4786",
            "fax_number": "916-636-4358"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7190 S CIMARRON RD",
            "city": "LAS VEGAS",
            "state": "NV",
            "postal_code": "891132171",
            "telephone_number": "702-675-3240",
            "fax_number": "702-982-6347"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PARK",
        "first_name": "CHAN",
        "middle_name": "JEROME",
        "credential": "MD, PHD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2011-03-31",
        "last_updated": "2024-10-30",
        "certification_date": "2024-10-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208G00000X",
            "taxonomy_group": "",
            "desc": "Thoracic Surgery (Cardiothoracic Vascular Surgery)",
            "state": "NV",
            "license": "20992",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Las Vegas, NV

Sources for this page

Verify at the official NPI Registry.