Kyu-Sik Park, M.D.

Primary specialty

Anesthesiology PhysicianTaxonomy code 207L00000X

License

75588 Issued in AZ

Practice address

269 S Candy LN
Cottonwood, AZ 86326

Phone

(928) 639-6150

NPI assigned

Feb 13, 2007

Last updated

Jan 22, 2025By the provider in NPPES

Sex

Male

Sole proprietor

No

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 MO, AZ2 enrollments

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 2

Specialty

Anesthesiology

Education

Indiana University School of Medicine, 2005

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Northern Arizona Healthcare CorporationGroup PAC ID 3577473362, 391 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Verde Valley Medical Center Hospital, Cottonwood, AZ, CCN 030007

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

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.

• Northern Arizona Healthcare Corporation

  • Family Medicine Physician
  • Flagstaff, AZ
  • NPI 1669914552

  Anesthesiology

  Medicare reassignment Care Compare group NPD
• Southeast Missouri Hospital Physicians, LLC

  dba Mercy Clinic Southeast

  • Family Medicine Physician
  • Cape Girardeau, MO
  • NPI 1558311522
  Medicare reassignment NPD
• Flagstaff Pathology Associates

  dba Pathology Associates of Northern AZ

  • Anatomic Pathology & Clinical Pathology Physician
  • Flagstaff, AZ
  • NPI 1306205612
  NPD
• Northern Arizona Healthcare Corporation

  dba Northern Arizona Healthcare Children's Health Center

  • Multi-Specialty Clinic/Center
  • Flagstaff, AZ
  • NPI 1235732702
  NPD
• Anesthesia Associates of Cape Girardeau PC

  • Pain Medicine (Anesthesiology) Physician
  • Cape Girardeau, MO
  • NPI 1194834077
  NPD (past)

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

• Verde Valley Medical Center

  • General Acute Care Hospital
  • Cottonwood, AZ
  • NPI 1346291648
  Care Compare affiliation
• Verde Valley Medical Center

  dba Northern Arizona Healthcare - Sedona

  • General Acute Care Hospital
  • Sedona, AZ
  • NPI 1538608716
  Care Compare affiliation

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

{
    "created_epoch": "1171324800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1737504000000",
    "number": "1952443202",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1200 N BEAVER ST",
            "address_2": "ATTN: PAYER CREDENTIALING",
            "city": "FLAGSTAFF",
            "state": "AZ",
            "postal_code": "860013118",
            "telephone_number": "928-213-6235",
            "fax_number": "928-213-6292"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "269 S CANDY LN",
            "city": "COTTONWOOD",
            "state": "AZ",
            "postal_code": "86326",
            "telephone_number": "928-639-6150"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "416 E Monroe St Ste 200",
            "address_purpose": "LOCATION",
            "city": "South Bend",
            "state": "IN",
            "postal_code": "466012360",
            "country_code": "US",
            "telephone_number": "574-232-8119",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "PARK",
        "first_name": "KYU-SIK",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-02-13",
        "last_updated": "2025-01-22",
        "certification_date": "2025-01-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207L00000X",
            "taxonomy_group": "",
            "desc": "Anesthesiology",
            "state": "KY",
            "license": "IP922",
            "primary": false
        },
        {
            "code": "207L00000X",
            "taxonomy_group": "",
            "desc": "Anesthesiology",
            "state": "AZ",
            "license": "75588",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Weihong Pan, M.D., PH.D.
• Manjinder Kaur Pannu
• Jeannine L. Paquette, P.A.
• Tyler Paradise
• Deborah Jean Pardee, PHD
• Danielle R Parrott, M.D.
• Meagan Patrick, PT
• Farshid Paydar, MD
• Nancey Payne, LPC
• Peak Solutions Counseling (Desert Foothills COunseling)

• Anesthesiology Physician in Cottonwood, AZ
• Providers in Cottonwood, AZ by specialty
• Anesthesiology Physician in Arizona

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 22, 2025; 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.
• 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.