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DR. SUSIE PARK M.D.
NPI 1114177300
Radiology - Pediatric Radiology in Albany, NY

Active since September 24, 2008PECOS Enrolled
92.56/100
CMS Quality Rating
43 NEW SCOTLAND AVE, DEPT OF RADIOLOGY MC 113, ALBANY, NY 12208(518) 262-3722 Get Directions Write a Review

NPPES record last updated: January 13, 2023. Verified against the NPPES registry weekly; last sync: October 18, 2026.

About Dr. Susie Park M.d. NPPES

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

DR. SUSIE PARK M.D. (NPI 1114177300) is an individual pediatric radiology provider in Albany, New York, licensed in New York (267437) and active in the NPI registry since September 2008. She is enrolled in Medicare PECOS.

NPPES Registry Identity

NPI1114177300
Entity TypeIndividualFemale
Primary Taxonomy2085P0229X
Provider Legal NameDR. SUSIE PARKCredential: M.D.
Location Address43 NEW SCOTLAND AVE, DEPT OF RADIOLOGY MC 113Albany, NY 12208-3412
Mailing Address711 Troy Schenectady Rd, Suite 203Latham, NY 12110-2442 · (518) 782-3700 · Fax (518) 782-3799
Phone(518) 262-3722
Sole ProprietorNo
Enumeration DateSeptember 24, 2008
Last NPPES UpdateJanuary 13, 2023
✔ NPI 1114177300 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyRadiology · Pediatric RadiologyAllopathic & Osteopathic Physicians
Taxonomy Code2085P0229X
License✔ Licensed in NY · 267437
Definition
A radiologist who is proficient in all forms of diagnostic imaging as it pertains to the treatment of diseases in the newborn, infant, child and adolescent. This specialist has knowledge of both imaging and interventional procedures related to the care and management of diseases of children. A pediatric radiologist must be highly knowledgeable of all organ systems as they relate to growth and development, congenital malformations, diseases peculiar to infants and children and diseases that begin in childhood but cause substantial residual impairment in adulthood.
43 NEW SCOTLAND AVE, Albany, NY 12208
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Other Identifiers 1

Medicaid03649323NY

Medicare Participation & PECOS CMS

Medicare enrollment, assignment, billing reassignment, and ordering and referring status from CMS.

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Dr. Susie Park M.d. is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

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.

Medicare Billing Reassignments

3

Medicare enrollment records show Susie Park reassigns Medicare billing to 3 organizations. Each organization bills Medicare for the services this provider delivers there; the nearest is listed first.

Golden State Imaging Associates Inc
1,492 mi
Diagnostic Radiology
1401 ST JOSEPH PKWY
Houston, TX 77002
  • Reassigned Medicare billing, California enrollment
  • 244 clinicians in this Medicare group
NPI 1144872052 (888) 371-0667
Southern California Permanente Medical Group
2,433 mi
Health Maintenance Organization
43112 N 15TH ST
Lancaster, CA 93534
  • Reassigned Medicare billing, California enrollment
  • 13,921 clinicians in this Medicare group
NPI 1982863783 (661) 726-2279
Los Alamitos Radiology Group Inc
2,456 mi
Diagnostic Radiology
3751 KATELLA AVE
Los Alamitos, CA 90720
  • Reassigned Medicare billing, California enrollment
  • 47 clinicians in this Medicare group
NPI 1427005024 (562) 799-3294

Source: CMS Revalidation Reassignment List, October 2026 release. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.

Medicare Quality Performance CMS QPP · MIPS

Performance in the CMS Quality Payment Program: the MIPS final score across four weighted categories, and the individual quality measures reported to Medicare.

92.56/100
MIPS Final ScoreMerit-based Incentive Payment System · CMS Quality Payment Program
Scored as part of a group practice
Quality91.25
Improvement Activities40

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.

MS. KELLY N MILES MS, RNC, NNP-BC
Nurse Practitioner (Neonatal, Critical Care)
43 NEW SCOTLAND AVE
ALBANY, NY 12208
Albany County (518) 262-9200
DR. NATHANIEL FRANCIS EKSTROM DO
Student in an Organized Health Care Education/Training Program
43 NEW SCOTLAND AVE, DEPT. OF EMERGENCY MEDICINE, MAIL CODE: 139
ALBANY, NY 12208
Albany County (518) 262-6455
JESSICA MARIE CARPENTER
Nurse Anesthetist, Certified Registered
43 NEW SCOTLAND AVE
ALBANY, NY 12208
Albany County (518) 332-3956
MS. RACHAEL RENEE GREY CNIM
Specialist/Technologist, Other (Electroneurodiagnostic)
43 NEW SCOTLAND AVE
ALBANY, NY 12208
Albany County (518) 262-3125
JOSNEL CID
Student in an Organized Health Care Education/Training Program
43 NEW SCOTLAND AVE
ALBANY, NY 12208
Albany County (518) 262-6488
DR. JOANNA MIDURA PALUCH DO
Student in an Organized Health Care Education/Training Program
43 NEW SCOTLAND AVE
ALBANY, NY 12208
Albany County (518) 262-0144
RITIKA PATEL
Student in an Organized Health Care Education/Training Program
43 NEW SCOTLAND AVE
ALBANY, NY 12208
Albany County (518) 262-3125
MISS CRISTINA LYNN SILVA MS CCC SLP
Speech-Language Pathologist
43 NEW SCOTLAND AVE, COMMUNICATION DISORDERS DEPARTMENT MC 128
ALBANY, NY 12208
Albany County (518) 262-4526

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 Susie Park's NPI number?

The NPI number for Susie Park is 1114177300. It was assigned to this individual provider in the NPPES registry on September 24, 2008.

Where is Susie Park located?

Susie Park practices at 43 New Scotland Ave Dept Of Radiology Mc 113, Albany, NY 12208. The listed phone number is (518) 262-3722.

What is Susie Park's specialty?

The primary specialty registered for this NPI is Radiology, specializing in Pediatric Radiology, with taxonomy code 2085P0229X.

Is Susie Park enrolled in Medicare?

Yes. Susie Park is registered in the Medicare PECOS enrollment system.

Which organizations bill Medicare for Susie Park's services?

According to the CMS Revalidation Reassignment List (October 2026 release), Susie Park reassigns Medicare benefits to 3 organizations: Golden State Imaging Associates Inc (Houston, TX), Southern California Permanente Medical Group (Lancaster, CA) and Los Alamitos Radiology Group Inc (Los Alamitos, CA). Each reassignment is filed with Medicare on form CMS-855R, signed by both the clinician and the organization, and lets the organization bill Medicare and receive payment for Susie Park's services. Reassignment records can lag staffing changes; confirm current arrangements with the organization.

When was this NPI record last updated?

The NPPES record for Susie Park was last updated on January 13, 2023. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 3 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.