NPIMap

Individual provider Active NPI

Eugene L Park, MD

  • Urology Physician
  • Petersburg, VA
National Provider Identifier
1992707137
Registry record updated Feb 5, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Urology PhysicianTaxonomy code 208800000X
License
0101247088 Issued in VA
Practice address
40 Medical Park Blvd Ste D
Petersburg, VA 23805
Phone
(804) 765-6100
Fax
(804) 765-6101
NPI assigned
Jun 1, 2005
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 5, 2020

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Urology Physician 208800000X 0101247088 VA Primary

Addresses

Primary practice location

40 Medical Park Blvd Ste D
Petersburg, VA 23805

Mailing address

8580 Magellan Pkwy
Richmond, VA 23227-1149
Phone (804) 765-6100

Other identifiers 2

IdentifierTypeStateIssuer
1992707137MedicaidVA
860777MedicaidAZ

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in VA
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
I20100921001348 VA Practitioner - Urology 2264421916 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Urology
Education
Northwestern University Feinberg Medical School, 1998
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Bon Secours Medical Group Richmond Specialty Care LLCGroup PAC ID 8022440056, 350 clinicians

Practice addresses (Care Compare)

1510 N 28TH St
Richmond, VA 23223-5311

281 E Hundred Rd
Chester, VA 23836-2613
Phone (804) 764-7885

40 Medical Park Blvd
Petersburg, VA 23805-9289

Hospital & facility affiliations

  • Bon Secours Southside Medical Center Hospital, Petersburg, VA, CCN 490067
  • Bon Secours St Marys Hospital Hospital, Richmond, VA, CCN 490059
  • Bon Secours St Francis Medical Center Hospital, Midlothian, VA, CCN 490136
  • Bon Secours Southern Virginia Medical Center Hospital, Emporia, VA, CCN 490097

Merit-based Incentive Payment System (MIPS)

Final score
80.61 of 100Reported as individual
Quality
68.25
Promoting interoperability
100
Improvement activities
40
Cost
67.1

Procedures performed for Medicare patients

ProcedureNumber of procedures
Prostate resection22
Melanoma (skin cancer) excision1-10
Removal of tissue1-10

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Bon Secours Medical Group Richmond Specialty Care LLC CurrentSince Jan 1, 2020 Accepting new patients
Bon Secours Medical Group Richmond Specialty Care LLC CurrentSince Jan 1, 2020 Accepting new patients
Urology Specialists of Richmond LLC Urology Past Accepting new patients
Frederick Health Hospital Inc Past Accepting new patients

Locations

281 E Hundred Rd
Chester, VA 23836
Phone (804) 452-1635

40 Medical Park Blvd
Ste B
Petersburg, VA 23805
Phone (804) 520-6730

40 Medical Park Blvd
Ste D
Petersburg, VA 23805
Phone (804) 765-5320

1510 N 28th St
Ste 110
Richmond, VA 23223
Phone (804) 545-2304

8580 Magellan Pkwy
Richmond, VA 23227
Phone (804) 627-5462

Interoperability endpoints

  • Direct secure messaging: epark1154459@direct.bsmhealth.org

Organizations & group practices 4

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.

Hospital & facility affiliations 19

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

View all 19

NPI Registry JSON

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

{
    "created_epoch": "1117584000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1580860800000",
    "number": "1992707137",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8580 MAGELLAN PKWY",
            "city": "RICHMOND",
            "state": "VA",
            "postal_code": "232271149",
            "telephone_number": "804-765-6100",
            "fax_number": "804-765-6101"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "40 MEDICAL PARK BLVD STE D",
            "city": "PETERSBURG",
            "state": "VA",
            "postal_code": "23805",
            "telephone_number": "804-765-6100",
            "fax_number": "804-765-6101"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PARK",
        "first_name": "EUGENE",
        "middle_name": "L",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-06-01",
        "last_updated": "2020-02-05",
        "certification_date": "2020-02-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208800000X",
            "taxonomy_group": "",
            "desc": "Urology",
            "state": "VA",
            "license": "0101247088",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1992707137",
            "state": "VA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "860777",
            "state": "AZ"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Petersburg, VA

Sources for this page

Verify at the official NPI Registry.