DR. HAELI PARK MD
NPI 1114422631
Pediatrics in Lodi, CA
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
Specialties & Licenses
Medicare Participation & PECOS CMS
Medicare enrollment, assignment, billing reassignment, and ordering and referring status from CMS.
Medicare Enrollment Status
Enrolled in Medicare (PECOS)
Dr. Haeli Park Md is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).
Medicare Billing Reassignments
2Medicare enrollment records show Haeli Park reassigns Medicare billing to 2 organizations. Each organization bills Medicare for the services this provider delivers there; the nearest is listed first.
Stockton, CA 95210
- Reassigned Medicare billing, California enrollment
- 20,078 clinicians in this Medicare group
Sacramento, CA 95817
- Reassigned Medicare billing, California enrollment
- 2,570 clinicians in this Medicare group
Source: CMS Revalidation Reassignment List, October 2026 release. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.
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.
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.
LODI, CA 95240
LODI, CA 95240
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.
Which organizations bill Medicare for Haeli Park's services?
According to the CMS Revalidation Reassignment List (October 2026 release), Haeli Park reassigns Medicare benefits to 2 organizations: Permanente Medical Group Inc (Stockton, CA) and Regents Of The Univ Of Ca (Sacramento, 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 Haeli 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 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.
# Dr. Haeli Park, MD · NPI 1114422631
Pediatrics physician in Lodi, California. Individual provider, active in the CMS NPPES registry since March 27, 2018.
## Identity
- **NPI:** 1114422631 (Entity type: Individual)
- **Enumerated:** March 27, 2018
- **Primary specialty:** Pediatrics · taxonomy 208000000X
- **State license:** A163831 (California)
- **Sole proprietor:** No
## Practice location
- **Address:** 975 S FAIRMONT AVE, Lodi, CA 95240-5118
- **Phone:** (209) 339-7639
## Medicare
- **Medicare:** Enrolled in Medicare (PECOS)
- **Ordering & referring:** eligible for Part B labs & imaging, durable medical equipment, home health, power mobility devices
- **Bills Medicare through:** 2 organizations under Medicare reassignment (form CMS-855R): Permanente Medical Group Inc (NPI 1548343510, Stockton, CA); Regents Of The Univ Of Ca (NPI 1447423959, Sacramento, CA) · CMS Revalidation Reassignment List, October 2026 release
## Record status
- **NPPES last updated:** August 1, 2021
---
Source: [NPI Profile](https://npiprofile.com/npi/1114422631) · Data from the CMS NPPES public registry.