Jung Tae Park, MD

Primary specialty

Adult Medicine PhysicianTaxonomy code 207QA0505X

License

MD0000010100 Issued in TN

Practice address

13851 Highway 28
Whitwell, TN 37397-5373

Phone

(423) 658-9200

Fax

(423) 658-2195

NPI assigned

Nov 2, 2005

Last updated

Dec 14, 2022By the provider in NPPES

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in TN

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

General Practice

Education

Other, 1966

Medicare assignment

May accept Medicare assignment

Group practices

Park MedicalGroup PAC ID 1456721224, 5 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Erlanger Medical Center Hospital, Chattanooga, TN, CCN 440104
• NHC Healthcare, Sequatchie Nursing home, Dunlap, TN, CCN 445126

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

Interoperability endpoints

• FHIR API: https://fhir.meditouchehr.com/api/fhir/r4/

All facility ownership & control disclosures 1

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

Owned or controlled facilities with NPI records 1

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

• NHC Healthcare-Sequatchie LLC

  • Skilled Nursing Facility
  • Dunlap, TN
  • NPI 1801811765

  Adp of the SNF, Operational/Managerial Control

  CMS ownership

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Ashley Ann Sartain, FNP-C

  • Nurse Practitioner
  • Coalmont, TN
  • NPI 1245791201
  Medicare reassignment

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.

• Park Medical

  • Rural Health Clinic/Center
  • Whitwell, TN
  • NPI 1124737408
  Medicare reassignment Care Compare group NPD
• Whitwell Medical Plaza

  dba Jung Tae Park

  • Primary Care Clinic/Center
  • Whitwell, TN
  • NPI 1225409147
  NPD (past) Authorized official
• Cleveland Tennessee Hospital Company LLC

  • Internal Medicine Physician
  • Cleveland, TN
  • NPI 1376723379
  NPD (past)
• Emergency Coverage Services, PC

  • Nurse Practitioner
  • Lawrenceburg, TN
  • NPI 1053351593
  NPD (past)
• Emergency Coverage, LLC

  dba Emergency Coverage Corporation of TeamHealth

  • Family Medicine Physician
  • Newport, TN
  • NPI 1427005008
  NPD (past)
• NHC Healthcare-Sequatchie LLC

  • Skilled Nursing Facility
  • Dunlap, TN
  • NPI 1801811765
  NPD (past)

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

• Erlanger Health

  • General Acute Care Hospital
  • Chattanooga, TN
  • NPI 1861194086
  Care Compare affiliation
• NHC Healthcare-Sequatchie LLC

  • Skilled Nursing Facility
  • Dunlap, TN
  • NPI 1801811765

  Nursing home

  Care Compare affiliation

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

{
    "created_epoch": "1130889600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1670976000000",
    "number": "1942291638",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 400",
            "address_2": "13851 HIGHWAY 28",
            "city": "WHITWELL",
            "state": "TN",
            "postal_code": "373970400",
            "telephone_number": "423-658-9200",
            "fax_number": "423-658-2195"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "13851 HIGHWAY 28",
            "city": "WHITWELL",
            "state": "TN",
            "postal_code": "373975373",
            "telephone_number": "423-658-9200",
            "fax_number": "423-658-2195"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PARK",
        "first_name": "JUNG",
        "middle_name": "TAE",
        "name_prefix": "Mr.",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2005-11-02",
        "last_updated": "2022-12-14",
        "certification_date": "2022-12-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207QA0505X",
            "taxonomy_group": "",
            "desc": "Family Medicine, Adult Medicine",
            "state": "TN",
            "license": "MD0000010100",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "B CARE",
            "identifier": "2002139",
            "state": "TN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Nonie Ivey Linder, LCSW
• Ingrid Rene Long, REGISTERED NURSE
• Frederick Kirk McDermott, M.A., LPC, MHSP
• David Alford Nunley
• Park Medical
• Kimberly Gean Redfearn, NP-C
• Delanie Alexis Roberts
• Donald Allen Smith
• Southern Home Care Services, Inc. (All Ways Caring HomeCare)
• Specialized Behavior Solutions

• Adult Medicine Physician in Whitwell, TN
• Providers in Whitwell, TN by specialty
• Adult Medicine Physician in Tennessee

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 14, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; facility enrollments, owners and changes of ownership; Provider of Services certification data; 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.