DR. SAMUEL S PARK M.D.
NPI 1124551239
Anesthesiology in Kirkland, WA
About Dr. Samuel S Park M.d. NPPES
Official registry information on file with the National Plan and Provider Enumeration System.
DR. SAMUEL S PARK M.D. (NPI 1124551239) is an individual anesthesiology provider in Kirkland, Washington, licensed in Washington (MD61147982) and active in the NPI registry since April 2017. He is enrolled in Medicare PECOS, is affiliated with Evergreenhealth Monroe, and is a graduate of University Of Washington School Of Medicine (2017).
NPPES Registry Identity
Specialties & Licenses
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
Dr. Samuel S Park M.d. 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 Samuel Park reassigns Medicare billing to 2 organizations. Each organization bills Medicare for the services this provider delivers there; the nearest is listed first.
Bellevue, WA 98004
- Reassigned Medicare billing, Washington enrollment
- 94 clinicians in this Medicare group
Bremerton, WA 98310
- Reassigned Medicare billing, Washington enrollment
- 1,526 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
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 2
Hospitals where this provider delivers care, identified from recent Medicare claims and place-of-service records.
Evergreenhealth Monroe
Acute Care Hospitals · Monroe, WAEvergreenhealth Medical Center
Acute Care Hospitals · Kirkland, WAOther Providers at the Same Location NPPES 20
Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.
KIRKLAND, WA 98034
KIRKLAND, WA 98034
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 Samuel Park's NPI number?
The NPI number for Samuel Park is 1124551239. It was assigned to this individual provider in the NPPES registry on April 5, 2017.
Where is Samuel Park located?
Samuel Park practices at 12040 NE 128th St, Kirkland, WA 98034. The listed phone number is (425) 899-3455.
What is Samuel Park's specialty?
The primary specialty registered for this NPI is Anesthesiology with taxonomy code 207L00000X.
Is Samuel Park enrolled in Medicare?
Yes. Samuel 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 Samuel Park's services?
According to the CMS Revalidation Reassignment List (October 2026 release), Samuel Park reassigns Medicare benefits to 2 organizations: Matrix Anesthesia, Ps (Bellevue, WA) and Franciscan Medical Group (Bremerton, WA). 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 Samuel Park's services. Reassignment records can lag staffing changes; confirm current arrangements with the organization.
What insurance does Samuel Park accept?
Health plans from Premera Blue Cross Blue Shield of Alaska list Samuel 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 Samuel Park affiliated with any hospitals?
According to CMS data, Samuel Park is affiliated with Evergreenhealth Monroe and Evergreenhealth Medical Center.
When was this NPI record last updated?
The NPPES record for Samuel Park was last updated on September 30, 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. Samuel S Park, M.D. · NPI 1124551239
Anesthesiology physician in Kirkland, Washington. Individual provider, active in the CMS NPPES registry since April 5, 2017.
## Identity
- **NPI:** 1124551239 (Entity type: Individual)
- **Enumerated:** April 5, 2017
- **Primary specialty:** Anesthesiology · taxonomy 207L00000X
- **State license:** MD61147982 (Washington)
- **Sole proprietor:** No
## Practice location
- **Address:** 12040 NE 128TH ST, Kirkland, WA 98034-3013
- **Phone:** (425) 899-3455
## 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): Matrix Anesthesia, Ps (NPI 1831146422, Bellevue, WA); Franciscan Medical Group (NPI 1154564649, Bremerton, WA) · CMS Revalidation Reassignment List, October 2026 release
- **Medical school:** University Of Washington School Of Medicine, class of 2017
## Record status
- **NPPES last updated:** September 30, 2021
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Source: [NPI Profile](https://npiprofile.com/npi/1124551239) · Data from the CMS NPPES public registry.