LILY PARK D.O.
NPI 1124333455
Dermatology in Modesto, CA

Q: What is Lily Park's NPI number?

The NPI number for Lily Park is 1124333455. It was assigned to this individual provider in the NPPES registry on August 11, 2010.

Q: What is Lily Park's specialty?

The primary specialty registered for this NPI is Dermatology with taxonomy code 207N00000X.

Q: When was this NPI record last updated?

The NPPES record for Lily Park was last updated on August 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 August 11, 2010PECOS EnrolledAccepts Medicare Assignment

600 COFFEE RD, MODESTO, CA 95355(209) 521-6097 Get Directions Write a Review

NPPES record last updated: August 8, 2024. Verified against the NPPES registry weekly; last sync: October 25, 2026.

Record update history: Aug 8, 2024, Jul 15, 2019, Mar 17, 2018 and 1 more (4 updates tracked since 2017).

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About Lily Park D.o. NPPES

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

LILY PARK D.O. (NPI 1124333455) is an individual dermatology provider in Modesto, California, licensed in California (12765) and active in the NPI registry since August 2010. She is enrolled in Medicare PECOS, maintains 3 additional practice locations, and is a graduate of Touro Un Col Of Osteopathic Medicine, Henderson (2010).

NPPES Registry Identity

NPI1124333455

Entity TypeIndividualFemale

Primary Taxonomy207N00000X

Provider Legal NameLILY PARKCredential: D.O.

Location Address600 COFFEE RDModesto, CA 95355-4201

Mailing Address3105 Cedar Ravine Rd, Ste 201Placerville, CA 95667-6561 · (530) 626-1602

Phone(209) 521-6097

Sole ProprietorNo

Medical School CMSTouro Un Col Of Osteopathic Medicine, HendersonGraduated 2010

Enumeration DateAugust 11, 2010

Last NPPES UpdateAugust 8, 20244 updates tracked since enumeration

NPPES CertifiedAugust 8, 2024

✔ NPI 1124333455 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 3

★ Primary SpecialtyDermatologyAllopathic & Osteopathic Physicians

Taxonomy Code207N00000X

License✔ Licensed in CA · 12765

Definition

A dermatologist is trained to diagnose and treat pediatric and adult patients with benign and malignant disorders of the skin, mouth, external genitalia, hair and nails, as well as a number of sexually transmitted diseases. The dermatologist has had additional training and experience in the diagnosis and treatment of skin cancers, melanomas, moles and other tumors of the skin, the management of contact dermatitis and other allergic and nonallergic skin disorders, and in the recognition of the skin manifestations of systemic (including internal malignancy) and infectious diseases. Dermatologists have special training in dermatopathology and in the surgical techniques used in dermatology. They also have expertise in the management of cosmetic disorders of the skin such as hair loss and scars and the skin changes associated with aging.

Also ListedInternal MedicineTaxonomy 207R00000X · License 20A12765 (CA), 5101018747 (MI), DO184048 (OR)

Also ListedHospitalistTaxonomy 208M00000X · License 20A12765 (CA)

600 COFFEE RD, Modesto, CA 95355

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Secondary Practice Locations 3

Location 1375 SE Norton Ln Ste CMcMinnville, OR 97128-8484 · Phone (503) 362-8385 · Fax (503) 362-8435

Location 21390 Waverly Dr SEAlbany, OR 97322-6958 · Phone (503) 362-8385

Location 3600 Coffee RdModesto, CA 95355-4201 · Phone (209) 521-6097 ext. 5289

Accepted Insurance

The full list of accepted plans is on the Insurance tab. Issuers include Oscar Health.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

Lily Park D.o. 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 ID1557590056

PECOS Enrollment IDI20140203001252, I20260612000035

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

Medicare enrollment records show Lily Park reassigns Medicare billing to 4 organizations. Each organization bills Medicare for the services this provider delivers there; the nearest is listed first.

Sutter Valley Medical Foundation

Same address

Multi-Specialty

600 COFFEE RD
Modesto, CA 95355

Reassigned Medicare billing, California enrollment
3,056 clinicians in this Medicare group

NPI 1669846986 (209) 524-1211

Regents Of The University Of California

58 mi

Multi-Specialty

9390 BIG HORN BLVD
Elk Grove, CA 95758

Reassigned Medicare billing, California enrollment
918 clinicians in this Medicare group

NPI 1174966071 (916) 683-3950

Regents Of The Univ Of Ca

67 mi

Clinical Child & Adolescent

2825 50TH ST
Sacramento, CA 95817

Reassigned Medicare billing, California enrollment
2,570 clinicians in this Medicare group

NPI 1447423959 (916) 703-0315

Schweiger Dermatology, PC

2,455 mi

Dermatology

420 FRONT ST
Elmer, NJ 08318

Reassigned Medicare billing, New Jersey enrollment
141 clinicians in this Medicare group

NPI 1104229392 (973) 878-0850

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 13

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.

Destruction of precancer skin growth, 2-14 growths 17003

This procedure involves removing 2-14 precancerous skin growths. The growths are treated to prevent them from potentially developing into skin cancer. The process is safe, with minimal discomfort, and promotes healthier skin.

662 services108 patients

Established patient office or other outpatient visit with low level od decision making, if using time, 20 minutes or more 99213

This is a routine visit for patients who have already been seen by the healthcare provider. During this approximately 20-29 minute appointment, your health status will be evaluated and any necessary treatments or tests will be discussed. It's a chance to address any health concerns you may have.

208 services193 patients

Destruction of skin growth, 1-14 growths 17110

"Destruction of skin growth" refers to a procedure where 1-14 abnormal skin growths are removed. This is done using methods such as freezing, burning, or laser therapy. It helps prevent the growth from causing discomfort or turning into a more serious condition.

166 services152 patients

Destruction of precancer skin growth, 1 growth 17000

"Destruction of precancer skin growth" is a procedure that eliminates a single precancerous skin growth. This is done to prevent it from developing into skin cancer. The growth may be removed using various methods such as cryotherapy (freezing), laser therapy, or topical medications.

164 services143 patients

Established patient office or other outpatient visit with moderate level of decision making, if using time, 30 minutes or more 99214

This is a routine check-up for patients who have previously visited our clinic. It involves a comprehensive review of your health and any ongoing treatments. The consultation lasts between 30-39 minutes, allowing enough time to discuss any concerns.

134 services117 patients

New patient office or other outpatient visit with low level of medical decision making, if using time, 30 minutes or more 99203

This service involves an initial office or outpatient visit for a new patient. The healthcare professional will spend 30-44 minutes understanding your health history, current issues, and discussing possible treatment plans. It's a comprehensive evaluation to start your healthcare journey.

32 services32 patients

Biopsy of related skin growth, first growth 11102

A biopsy of a skin growth involves taking a small sample of the growth to examine it under a microscope. This helps determine if the growth is harmful. The procedure is typically quick, with minimal discomfort. It's a crucial step in ensuring your skin's health.

27 services27 patients

Punch biopsy, first skin growth 11104

A punch biopsy is a procedure where a small, circular tool is used to remove a sample of skin tissue. This is usually done to test a skin growth for potential issues. You may feel a pinch, but discomfort is minimal. The area heals quickly.

17 services17 patients

Removal and microscopic exam of growth of head, neck, hands, feet, or genitals, 1-5 tissue blocks 17311

This procedure involves the careful removal of a growth from the head, neck, hands, or feet. The removed tissue, divided into 1-5 blocks, is then examined under a microscope to study its characteristics and determine the nature of the growth.

17 services17 patients

New patient office or other outpatient visit with moderate level of medical decision making, if using time, 45 minutes or more 99204

This is a first-time office or outpatient visit lasting between 45-59 minutes. The healthcare provider evaluates your health, discusses your medical history, and may suggest further tests or treatments. It's an opportunity to ask questions and understand your health better.

16 services16 patients

Application of light by qualified health care professional to destroy precancer skin growth 96573

This procedure involves a healthcare professional using a special light to target and destroy precancerous skin growths. It's a non-invasive method aimed at preventing the development of skin cancer. The process is safe, performed by trained professionals, and usually quick.

14 services14 patients

Aminolevulinic acid hcl for topical administration, 20%, single unit dosage form (354 mg) J7308

Aminolevulinic Acid HCL is a medication applied to the skin to treat certain types of skin conditions. It works by making the skin more sensitive to light, which helps to kill abnormal skin cells. The 20% solution is a single dose of 354 mg.

14 services14 patients

Destruction of precancer skin growth, 15 or more growths 17004

This procedure involves removing 15 or more precancerous skin growths to prevent them from developing into cancer. It's done using various methods like freezing, creams, or minor surgery. The goal is to protect your health by stopping cancer before it starts.

11 services11 patients

Physician Visit Costs CMS claims · ZIP area

Typical Medicare office-visit costs in the 95355 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

$73.16 typical visit price

range $19.28 – $144.60

Typical copayment $18.29 (range $4.82 – $36.15)

Most-billed visit code 99213

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.

RADHA CHIRUMAMILLA M.D.

Hospitalist