ETERN S PARK DDS, MD
NPI 1124289905
Dentist - Oral and Maxillofacial Surgery in Fargo, ND
About Etern S Park Dds, Md NPPES
Official registry information on file with the National Plan and Provider Enumeration System.
ETERN S PARK DDS, MD (NPI 1124289905) is an individual oral and maxillofacial surgery provider in Fargo, North Dakota, licensed in New York (053210) and active in the NPI registry since June 2008. He is enrolled in Medicare PECOS, is affiliated with Sanford Medical Center Fargo, and is a graduate of Other (2008).
NPPES Registry Identity
Specialties & Licenses 2
Accepted Insurance
Medicare Participation & PECOS CMS
Medicare enrollment, assignment, billing reassignment, and ordering and referring status from CMS.
Medicare Enrollment Status
Enrolled in Medicare and accepts Medicare assignment
Etern S Park Dds, Md 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.
Medicare Billing Reassignments
2Medicare enrollment records show Etern Park reassigns Medicare billing to 2 organizations. Each organization bills Medicare for the services this provider delivers there; the nearest is listed first.
Fargo, ND 58102
- Reassigned Medicare billing, North Dakota enrollment
- 1,464 clinicians in this Medicare group
Wilmington, DE 19801
- Reassigned Medicare billing, Delaware enrollment
- 7 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.
Areas of Expertise CMS Part B claims 2
Services this provider delivered to Medicare fee-for-service patients, from the CMS Medicare utilization data. Higher counts generally reflect more experience with a service; care delivered outside Medicare is not included.
Hospital Affiliations CMS Care Compare
Hospitals where this provider delivers care, identified from recent Medicare claims and place-of-service records.
Sanford Medical Center Fargo
Acute Care Hospitals · Fargo, NDPhysician Visit Costs CMS claims · ZIP area
Typical Medicare office-visit costs in the 58103 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.
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 Etern Park's NPI number?
The NPI number for Etern Park is 1124289905. It was assigned to this individual provider in the NPPES registry on June 24, 2008.
Where is Etern Park located?
Etern Park practices at 1717 University Dr S, Fargo, ND 58103. The listed phone number is (701) 234-2000.
What is Etern Park's specialty?
The primary specialty registered for this NPI is Dentist, specializing in Oral and Maxillofacial Surgery, with taxonomy code 1223S0112X.
Is Etern Park enrolled in Medicare?
Yes. Etern 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.
Which organizations bill Medicare for Etern Park's services?
According to the CMS Revalidation Reassignment List (October 2026 release), Etern Park reassigns Medicare benefits to 2 organizations: Sanford Medical Center Fargo (Fargo, ND) and Christiana Care Health Services Inc (Wilmington, DE). 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 Etern Park's services. Reassignment records can lag staffing changes; confirm current arrangements with the organization.
What insurance does Etern Park accept?
Health plans from AmeriHealth Caritas Next, Blue Cross Blue Shield of North Dakota, Blue Cross and Blue Shield of Montana, Blue Cross and Blue Shield of Oklahoma and Blue Cross and Blue Shield of Texas and 5 other insurers list Etern 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 Etern Park affiliated with any hospitals?
According to CMS data, Etern Park is affiliated with Sanford Medical Center Fargo.
When was this NPI record last updated?
The NPPES record for Etern Park was last updated on February 11, 2025. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 20 months 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.
# Etern S Park, DDS, MD · NPI 1124289905
Oral and Maxillofacial Surgery provider in Fargo, North Dakota. Individual provider, active in the CMS NPPES registry since June 24, 2008.
## Identity
- **NPI:** 1124289905 (Entity type: Individual)
- **Enumerated:** June 24, 2008
- **Primary specialty:** Dentist - Oral and Maxillofacial Surgery · taxonomy 1223S0112X
- **State license:** 053210 (New York)
- **Sole proprietor:** No
## Practice location
- **Address:** 1717 UNIVERSITY DR S, Fargo, ND 58103-4939
- **Phone:** (701) 234-2000
## Medicare
- **Medicare:** Enrolled (PECOS); accepts Medicare assignment
- **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): Sanford Medical Center Fargo (NPI 1952323974, Fargo, ND); Christiana Care Health Services Inc (NPI 1194073411, Wilmington, DE) · CMS Revalidation Reassignment List, October 2026 release
- **Medical school:** Other, class of 2008
## Record status
- **NPPES last updated:** February 11, 2025
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Source: [NPI Profile](https://npiprofile.com/npi/1124289905) · Data from the CMS NPPES public registry.