MARIA A PARK P.A.
NPI 1104263979
Physician Assistant - Medical in Milwaukee, WI

Q: What is Maria Park's NPI number?

The NPI number for Maria Park is 1104263979. It was assigned to this individual provider in the NPPES registry on June 3, 2013.

Q: What is Maria Park's specialty?

The primary specialty registered for this NPI is Physician Assistant, specializing in Medical, with taxonomy code 363AM0700X.

Q: When was this NPI record last updated?

The NPPES record for Maria Park was last updated on January 8, 2024. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 2 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.

Active since June 03, 2013PECOS EnrolledAccepts Medicare Assignment

9200 W WISCONSIN AVENUE, COLORECTAL SURGERY, MILWAUKEE, WI 53226(414) 955-5783(414) 955-0087 Get Directions Write a Review

NPPES record last updated: January 8, 2024. Verified against the NPPES registry weekly; last sync: August 09, 2026.

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About Maria A Park P.a. NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

MARIA A PARK P.A. (NPI 1104263979) is an individual medical provider in Milwaukee, Wisconsin, licensed in Wisconsin (3119-23) and active in the NPI registry since June 2013. She is enrolled in Medicare PECOS, is affiliated with Froedtert Memorial Lutheran Hospital, and is a graduate of Other (2013).

NPPES Registry Identity

NPI1104263979

Entity TypeIndividualFemale

Primary Taxonomy363AM0700X

Provider Legal NameMARIA A PARKCredential: P.A.

Location Address9200 W WISCONSIN AVENUE, COLORECTAL SURGERYMilwaukee, WI 53226-3522

Mailing Address9200 W Wisconsin Avenue, Colorectal SurgeryMilwaukee, WI 53226-3522 · (414) 955-5783 · Fax (414) 955-0087

Phone(414) 955-5783

Fax(414) 955-0087

Sole ProprietorNo

Medical School CMSOtherGraduated 2013

Enumeration DateJune 3, 2013

Last NPPES UpdateJanuary 8, 2024

NPPES CertifiedJanuary 5, 2024

✔ NPI 1104263979 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 3

★ Primary SpecialtyPhysician Assistant · MedicalPhysician Assistants & Advanced Practice Nursing Providers

Taxonomy Code363AM0700X

License✔ Licensed in WI · 3119-23

Also ListedPhysician AssistantTaxonomy 363A00000X · License 3119-23 (WI)

Also ListedPhysician Assistant · SurgicalTaxonomy 363AS0400X · License 3119-23 (WI)

9200 W WISCONSIN AVENUE, Milwaukee, WI 53226

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Other Identifiers 1

Medicaid1104263979WI

Accepted Insurance

The full list of accepted plans is on the Insurance tab. Issuers include Anthem Blue Cross and Blue Shield, CareSource (Common Ground Healthcare), HealthPartners and more.Insurance ›

Medicare Participation & PECOS CMS

Medicare enrollment, assignment, and ordering and referring status from the CMS PECOS system.

Medicare Enrollment Status

✔

Enrolled in Medicare and accepts Medicare assignment

Maria A Park P.a. is registered in PECOS and agrees to accept the Medicare-approved amount as full payment. Medicare patients are not billed beyond the standard deductible and coinsurance.

PECOS PAC ID9436390010

PECOS Enrollment IDI20130724000279

Eligible to Order & Refer✔ Part B Labs & Imaging✔ Durable Medical Equipment✔ Home Health Agency✔ Power Mobility DevicesPer the CMS Ordering and Referring file. Eligibility means Medicare pays claims that this provider orders or refers for these categories.

Hospital Affiliations CMS Care Compare

Hospitals where this provider delivers care, identified from recent Medicare claims and place-of-service records.

Froedtert Memorial Lutheran Hospital

Acute Care Hospitals · Milwaukee, WI

5/5 CMS rating

OwnershipVoluntary non-profit - Private

CMS Certification Number520177

Location9200 W Wisconsin AveMilwaukee, WI 53226 · Milwaukee County

Emergency services Birthing friendly

Other Providers at the Same Location NPPES 20

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

DR. MARK WALTER BOSBOUS

Plastic Surgery

9200 W WISCONSIN AVENUE, PLASTIC SURGERY
MILWAUKEE, WI 53226

Milwaukee County (414) 805-3666

DR. BRIAN ROBERTSON-DICK MD

Physical Medicine & Rehabilitation

9200 W WISCONSIN AVENUE, PHYSICAL MEDICINE AND REHABILITATION
MILWAUKEE, WI 53226

Milwaukee County (414) 805-7342

SUPATRA A AGARWAL AA

Anesthesiologist Assistant

9200 W WISCONSIN AVENUE, DEPARTMENT OF ANESTHESIOLOGY
MILWAUKEE, WI 53226

Milwaukee County (414) 805-8700

PROF. KONDRAGUNTA RAJENDRA PRASAD MD

Transplant Surgery

9200 W WISCONSIN AVENUE
MILWAUKEE, WI 53226

Milwaukee County (414) 805-6400

DR. PRERNA RAJ PANDYA M.D.

Obstetrics & Gynecology (Urogynecology and Reconstructive Pelvic Surgery)

9200 W WISCONSIN AVENUE, UROGYNECOLOGY
MILWAUKEE, WI 53226

Milwaukee County (414) 805-3666

SHERVIN MIRSHAHI M.D.

Radiology (Diagnostic Radiology)

9200 W WISCONSIN AVENUE, DEPARTMENT OF RADIOLOGY
MILWAUKEE, WI 53226

Milwaukee County (414) 805-2060

JING QI MD

Radiology (Diagnostic Radiology)

9200 W WISCONSIN AVENUE, DEPARTMENT OF RADIOLOGY
MILWAUKEE, WI 53226

Milwaukee County (414) 805-2060

MR. BRIAN G CARLSON MSN

Nurse Practitioner (Acute Care)

9200 W WISCONSIN AVENUE, DEPARTMENT OF RADIOLOGY
MILWAUKEE, WI 53226

Milwaukee County (414) 805-3750

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Maria Park's NPI number?

The NPI number for Maria Park is 1104263979. It was assigned to this individual provider in the NPPES registry on June 3, 2013.

Where is Maria Park located?

Maria Park practices at 9200 W Wisconsin Avenue Colorectal Surgery, Milwaukee, WI 53226. The listed phone number is (414) 955-5783.

What is Maria Park's specialty?

The primary specialty registered for this NPI is Physician Assistant, specializing in Medical, with taxonomy code 363AM0700X.

Is Maria Park enrolled in Medicare?

Yes. Maria Park is registered in the Medicare PECOS system and accepts Medicare assignment, which means accepting the Medicare-approved amount as payment in full for covered services.

What insurance does Maria Park accept?

Health plans from Anthem Blue Cross and Blue Shield, CareSource (Common Ground Healthcare), HealthPartners and Network Health list Maria Park as in-network in at least one marketplace plan. Coverage varies by plan and year; verify with the insurer or the provider before a visit.

Is Maria Park affiliated with any hospitals?

According to CMS data, Maria Park is affiliated with Froedtert Memorial Lutheran Hospital.

When was this NPI record last updated?

The NPPES record for Maria Park was last updated on January 8, 2024. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 2 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.