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MRS. JI YOUNG PARK NP
NPI 1609687508
Nurse Practitioner - Adult Health in New Hyde Park, NY

Active since January 20, 2025PECOS Enrolled
23 LAWRENCE ST, NEW HYDE PARK, NY 11040(516) 417-7248 Get Directions Write a Review

NPPES record last updated: June 22, 2025. Verified against the NPPES registry weekly; last sync: October 18, 2026.

About Mrs. Ji Young Park Np NPPES

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

MRS. JI YOUNG PARK NP (NPI 1609687508) is an individual adult health provider in New Hyde Park, New York, licensed in New York (F311044-01) and active in the NPI registry since January 2025. She is enrolled in Medicare PECOS and is a graduate of Other (2022).

NPPES Registry Identity

NPI1609687508
Entity TypeIndividualFemale
Primary Taxonomy363LA2200X
Provider Legal NameMRS. JI YOUNG PARKCredential: NP
Location Address23 LAWRENCE STNew Hyde Park, NY 11040-1720
Mailing Address23 Lawrence StNew Hyde Park, NY 11040-1720 · (516) 417-7248
Phone(516) 417-7248
Sole ProprietorYes
Medical School CMSOtherGraduated 2022
Enumeration DateJanuary 20, 2025
Last NPPES UpdateJune 22, 2025
NPPES CertifiedJune 22, 2025
✔ NPI 1609687508 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 2

★ Primary SpecialtyNurse Practitioner · Adult HealthPhysician Assistants & Advanced Practice Nursing Providers
Taxonomy Code363LA2200X
License✔ Licensed in NY · F311044-01
Also ListedRegistered Nurse · Psychiatric/Mental HealthTaxonomy 163WP0808X · License 684423 (NY)
23 LAWRENCE ST, New Hyde Park, NY 11040
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Medicare Participation & PECOS CMS

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

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Mrs. Ji Young Park Np is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

PECOS PAC ID446744932
PECOS Enrollment IDI20251211002345
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 Ji Young Park reassigns Medicare billing to 1 organization. The organization bills Medicare for the services this provider delivers there.

Matrix Medical Of New York PC
15 mi
Nurse Practitioner
1740 BROADWAY
New York, NY 10019
  • Reassigned Medicare billing, New York enrollment
  • 114 clinicians in this Medicare group
NPI 1639433063 (480) 862-1677

Source: CMS Revalidation Reassignment List, October 2026 release. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.

Physician Visit Costs CMS claims · ZIP area

Typical Medicare office-visit costs in the 11040 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
$105.06 typical visit price
range $67.40 – $203.53
Typical copayment $26.26 (range $16.85 – $50.88)
Most-billed visit code 99203
Established Patient
$117.62 typical visit price
range $21.66 – $164.45
Typical copayment $29.40 (range $5.41 – $41.11)
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 Ji Young Park's NPI number?

The NPI number for Ji Young Park is 1609687508. It was assigned to this individual provider in the NPPES registry on January 20, 2025.

Where is Ji Young Park located?

Ji Young Park practices at 23 Lawrence St, New Hyde Park, NY 11040. The listed phone number is (516) 417-7248.

What is Ji Young Park's specialty?

The primary specialty registered for this NPI is Nurse Practitioner, specializing in Adult Health, with taxonomy code 363LA2200X.

Is Ji Young Park enrolled in Medicare?

Yes. Ji Young Park is registered in the Medicare PECOS enrollment system.

Which organization bills Medicare for Ji Young Park's services?

According to the CMS Revalidation Reassignment List (October 2026 release), Ji Young Park reassigns Medicare benefits to Matrix Medical Of New York PC (New York, NY). 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 Ji Young 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 Ji Young Park was last updated on June 22, 2025. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 16 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.