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RUSSELL DEAN PARK PHD
NPI 1326020710
Psychologist - Clinical in Jamestown, CA

Active since November 19, 2005PECOS Enrolled
5100 O'BYRNES FERRY RD., JAMESTOWN, CA 95327(209) 984-5291 Get Directions Write a Review

NPPES record last updated: April 4, 2013. Verified against the NPPES registry weekly; last sync: October 18, 2026.

About Russell Dean Park Phd NPPES

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

RUSSELL DEAN PARK PHD (NPI 1326020710) is an individual clinical provider in Jamestown, California, licensed in California (PSY14275) and active in the NPI registry since November 2005. He is enrolled in Medicare PECOS.

NPPES Registry Identity

NPI1326020710
Entity TypeIndividualMale
Primary Taxonomy103TC0700X
Provider Legal NameRUSSELL DEAN PARKCredential: PHD
Location Address5100 O'BYRNES FERRY RD.Jamestown, CA 95327
Mailing AddressPo Box 215Monte Rio, CA 95462-0215 · (209) 380-3932
Phone(209) 984-5291
Sole ProprietorNo
Enumeration DateNovember 19, 2005
Last NPPES UpdateApril 4, 2013
✔ NPI 1326020710 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyPsychologist · ClinicalBehavioral Health & Social Service Providers
Taxonomy Code103TC0700X
License✔ Licensed in CA · PSY14275
Definition
A psychologist who provides continuing and comprehensive mental and behavioral health care for individuals and families; consultation to agencies and communities; training, education and supervision; and research-based practice. It is a specialty in breadth -- one that is broadly inclusive of severe psychopathology -- and marked by comprehensiveness and integration of knowledge and skill from a broad array of disciplines within and outside of psychology proper. The scope of clinical psychology encompasses all ages, multiple diversities and varied systems.
5100 O'BYRNES FERRY RD., Jamestown, CA 95327
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Other Identifiers 1

Medicare ID-Type UnspecifiedOPL142750CA

Medicare Participation & PECOS CMS

Medicare enrollment, assignment, billing reassignment, and ordering and referring status from CMS.

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Russell Dean Park Phd 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.

Medicare Billing Reassignment

Medicare enrollment records show Russell Park reassigns Medicare billing to 1 organization. The organization bills Medicare for the services this provider delivers there.

Memory Check Psychological Services, A Professional Corporation
377 mi
Clinical
1902 WRIGHT PL FL CENTER2
Carlsbad, CA 92008
  • Reassigned Medicare billing, California enrollment
  • 223 clinicians in this Medicare group
NPI 1912184219 (888) 515-3834

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 3

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.

Psychiatric diagnostic evaluation 90791
A psychiatric diagnostic evaluation is a thorough assessment used to identify any mental health conditions you may have. It involves a detailed discussion about your symptoms, thoughts, feelings and behavior patterns. Your medical history and family's mental health history are also considered.
298 services282 patients
Psychiatric diagnostic evaluation 90791
A psychiatric diagnostic evaluation is a thorough assessment used to identify any mental health conditions you may have. It involves a detailed discussion about your symptoms, thoughts, feelings and behavior patterns. Your medical history and family's mental health history are also considered.
17 services17 patients
Psychotherapy, 45 minutes 90834
Psychotherapy is a treatment method where you converse with a therapist about your thoughts, feelings, and behaviors. In a 45-minute session, the therapist assists you in understanding and managing your mental health concerns, improving emotional wellness, and promoting personal growth.
17 services16 patients

Physician Visit Costs CMS claims · ZIP area

Typical Medicare office-visit costs in the 95327 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
$176.60 typical visit price
range $58.87 – $176.60
Typical copayment $44.15 (range $14.71 – $44.15)
Most-billed visit code 99205
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.

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 Russell Park's NPI number?

The NPI number for Russell Park is 1326020710. It was assigned to this individual provider in the NPPES registry on November 19, 2005.

Where is Russell Park located?

Russell Park practices at 5100 O'byrnes Ferry Rd., Jamestown, CA 95327. The listed phone number is (209) 984-5291.

What is Russell Park's specialty?

The primary specialty registered for this NPI is Psychologist, specializing in Clinical, with taxonomy code 103TC0700X.

Is Russell Park enrolled in Medicare?

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

Which organization bills Medicare for Russell Park's services?

According to the CMS Revalidation Reassignment List (October 2026 release), Russell Park reassigns Medicare benefits to Memory Check Psychological Services, A Professional Corporation (Carlsbad, CA). The 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 Russell 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 Russell Park was last updated on April 4, 2013. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 13 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.