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DR. HAELI PARK MD
NPI 1114422631
Pediatrics in Lodi, CA

Active since March 27, 2018PECOS Enrolled
975 S FAIRMONT AVE, LODI, CA 95240(209) 339-7639 Get Directions Write a Review

NPPES record last updated: August 1, 2021. Verified against the NPPES registry weekly; last sync: August 02, 2026.

About Dr. Haeli Park Md NPPES

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

DR. HAELI PARK MD (NPI 1114422631) is an individual pediatrics provider in Lodi, California, licensed in California (A163831) and active in the NPI registry since March 2018. She is enrolled in Medicare PECOS.

NPPES Registry Identity

NPI1114422631
Entity TypeIndividualFemale
Primary Taxonomy208000000X
Provider Legal NameDR. HAELI PARKCredential: MD
Location Address975 S FAIRMONT AVELodi, CA 95240-5118
Mailing Address2300 Stockton Blvd Ste 1700Sacramento, CA 95817-2202 · (209) 339-7639
Phone(209) 339-7639
Sole ProprietorNo
Enumeration DateMarch 27, 2018
Last NPPES UpdateAugust 1, 2021
NPPES CertifiedAugust 1, 2021
✔ NPI 1114422631 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyPediatricsAllopathic & Osteopathic Physicians
Taxonomy Code208000000X
License✔ Licensed in CA · A163831
Definition
A pediatrician is concerned with the physical, emotional and social health of children from birth to young adulthood. Care encompasses a broad spectrum of health services ranging from preventive healthcare to the diagnosis and treatment of acute and chronic diseases. A pediatrician deals with biological, social and environmental influences on the developing child, and with the impact of disease and dysfunction on development.
975 S FAIRMONT AVE, Lodi, CA 95240
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Accepted Insurance

The full list of accepted plans is on the Insurance tab. Issuers include Blue Cross and Blue Shield of Kansas, Inc..Insurance ›

Medicare Participation & PECOS CMS

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

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Dr. Haeli Park Md 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.

Physician Visit Costs CMS claims · ZIP area

Typical Medicare office-visit costs in the 95240 ZIP code area, from fee-for-service claims. These are area statistics, not this provider’s prices; actual charges vary by service and coverage.

New Patient
$90.32 typical visit price
range $58.87 – $176.60
Typical copayment $22.58 (range $14.71 – $44.15)
Most-billed visit code 99203
Established Patient
$103.36 typical visit price
range $19.28 – $144.60
Typical copayment $25.84 (range $4.82 – $36.15)
Most-billed visit code 99214
Amounts reflect what Medicare beneficiaries in this ZIP area are typically charged for office visits. Patients with other coverage should check their individual plans.

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.

TERI SPRING RD
Dietitian, Registered
975 S FAIRMONT AVE
LODI, CA 95240
San Joaquin County (209) 334-3411
DIAGNOSTIC PATHOLOGY MEDICAL GROUP INC
Pathology (Anatomic Pathology & Clinical Pathology)
975 S FAIRMONT AVE
LODI, CA 95240
San Joaquin County (916) 447-6267
DR. KEVIN EARL RABEY M.D.
Emergency Medicine
975 S FAIRMONT AVE
LODI, CA 95240
San Joaquin County (209) 334-3411
ARIANNA BUSH
Physician Assistant
975 S FAIRMONT AVE
LODI, CA 95240
San Joaquin County (209) 334-3411
LODI MEMORIAL HOSPTIAL PHARMACY WEST
Pharmacy (Clinic Pharmacy)
975 S FAIRMONT AVE, 2415 W VINE #104
LODI, CA 95240
San Joaquin County (209) 334-3411
MRS. KRISTINA FORTES FNP, MSN, RN
Nurse Practitioner (Family)
975 S FAIRMONT AVE
LODI, CA 95240
San Joaquin County (209) 334-3411
ADAM JOSEPH WOODYARD DO
Radiology (Diagnostic Radiology)
975 S FAIRMONT AVE
LODI, CA 95240
San Joaquin County (209) 334-3411
LANCY LU
Pediatrics
975 S FAIRMONT AVE
LODI, CA 95240
San Joaquin County (209) 339-7639

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 Haeli Park's NPI number?

The NPI number for Haeli Park is 1114422631. It was assigned to this individual provider in the NPPES registry on March 27, 2018.

Where is Haeli Park located?

Haeli Park practices at 975 S Fairmont Ave, Lodi, CA 95240. The listed phone number is (209) 339-7639.

What is Haeli Park's specialty?

The primary specialty registered for this NPI is Pediatrics with taxonomy code 208000000X.

Is Haeli Park enrolled in Medicare?

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

What insurance does Haeli Park accept?

Health plans from Blue Cross and Blue Shield of Kansas, Inc. list Haeli 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.

When was this NPI record last updated?

The NPPES record for Haeli Park was last updated on August 1, 2021. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 5 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.