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KELLY PARK D.O.
NPI 1346536349
Obstetrics & Gynecology in Antioch, CA

Active since June 28, 2011PECOS Enrolled
4501 SAND CREEK RD, ANTIOCH, CA 94531(925) 813-6500 Get Directions Write a Review

NPPES record last updated: January 25, 2023. Verified against the NPPES registry weekly; last sync: August 02, 2026.

Record update history: Jan 25, 2023, Nov 3, 2022, Sep 14, 2020 and 1 more (4 updates tracked since 2016).

About Kelly Park D.o. NPPES

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

KELLY PARK D.O. (NPI 1346536349) is an individual obstetrics & gynecology provider in Antioch, California, licensed in California (20007) and active in the NPI registry since June 2011. She is enrolled in Medicare PECOS.

NPPES Registry Identity

NPI1346536349
Entity TypeIndividualFemale
Primary Taxonomy207V00000X
Provider Legal NameKELLY PARKCredential: D.O.
Location Address4501 SAND CREEK RDAntioch, CA 94531-8687
Mailing Address4501 Sand Creek RdAntioch, CA 94531-8687
Phone(925) 813-6500
Sole ProprietorNo
Enumeration DateJune 28, 2011
Last NPPES UpdateJanuary 25, 20234 updates tracked since enumeration
NPPES CertifiedJanuary 25, 2023
✔ NPI 1346536349 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 2

★ Primary SpecialtyObstetrics & GynecologyAllopathic & Osteopathic Physicians
Taxonomy Code207V00000X
Licenses✔ Licensed in CA · 20007✔ Licensed in NJ · 25MB10893000
Definition
An obstetrician/gynecologist possesses special knowledge, skills and professional capability in the medical and surgical care of the female reproductive system and associated disorders. This physician serves as a consultant to other physicians and as a primary physician for women.
Also ListedStudent in an Organized Health Care Education/Training ProgramTaxonomy 390200000X
4501 SAND CREEK RD, Antioch, CA 94531
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Medicare Participation & PECOS CMS

Medicare enrollment, assignment, and ordering and referring status from the CMS PECOS system.

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Kelly Park D.o. 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.

Physician Visit Costs CMS claims · ZIP area

Typical Medicare office-visit costs in the 94531 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
$153.83 typical visit price
range $69.00 – $202.35
Typical copayment $38.45 (range $17.25 – $50.58)
Most-billed visit code 99204
Established Patient
$84.91 typical visit price
range $23.44 – $166.46
Typical copayment $21.22 (range $5.86 – $41.61)
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.

KRISTEN ASAKO SHIMODA PHARMD
Pharmacist (Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist)
4501 SAND CREEK RD
ANTIOCH, CA 94531
Contra Costa County (925) 813-7280
DR. KAUSALYA CHENNAPRAGADA BHASKARABHATLA M.D.
Internal Medicine
4501 SAND CREEK RD
ANTIOCH, CA 94531
Contra Costa County (925) 813-6500
JEFFREY ROBERT CHAVEZ PA-C
Physician Assistant
4501 SAND CREEK RD
ANTIOCH, CA 94531
Contra Costa County (925) 389-7719
DR. JAMES FRANCIS CHAN M.D.
Hospitalist
4501 SAND CREEK RD
ANTIOCH, CA 94531
Contra Costa County (925) 813-6500
JACOB FREDRICKSON DPT
Physical Therapist
4501 SAND CREEK RD
ANTIOCH, CA 94531
Contra Costa County (925) 813-6500
MENG HAO
Pharmacist
4501 SAND CREEK RD
ANTIOCH, CA 94531
Contra Costa County (925) 813-6500
TIMOTHY VAN PHAN
Pharmacist
4501 SAND CREEK RD
ANTIOCH, CA 94531
Contra Costa County (925) 813-6500
SHARON ANN LEWIS RRT
Respiratory Therapist, Registered
4501 SAND CREEK RD
ANTIOCH, CA 94531
Contra Costa County (925) 813-6700

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 Kelly Park's NPI number?

The NPI number for Kelly Park is 1346536349. It was assigned to this individual provider in the NPPES registry on June 28, 2011.

Where is Kelly Park located?

Kelly Park practices at 4501 Sand Creek Rd, Antioch, CA 94531. The listed phone number is (925) 813-6500.

What is Kelly Park's specialty?

The primary specialty registered for this NPI is Obstetrics & Gynecology with taxonomy code 207V00000X.

Is Kelly Park enrolled in Medicare?

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

When was this NPI record last updated?

The NPPES record for Kelly Park was last updated on January 25, 2023. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 3 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.