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DR. JI-KWAN PARK MD, MPH
NPI 1619322898
Ophthalmology - Ophthalmic Plastic and Reconstructive Surgery in Carmel, IN

Active since April 26, 2016PECOS EnrolledAccepts Medicare Assignment
77.59/100
CMS Quality Rating
201 PENNSYLVANIA PKWY STE 225, CARMEL, IN 46280(371) 573-1000 Get Directions Write a Review

NPPES record last updated: April 21, 2021. Verified against the NPPES registry weekly; last sync: October 18, 2026.

Record update history: Aug 14, 2023, Apr 21, 2021, Jul 23, 2020 (3 updates tracked since 2020).

About Dr. Ji-kwan Park Md, Mph NPPES

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

DR. JI-KWAN PARK MD, MPH (NPI 1619322898) is an individual ophthalmic plastic and reconstructive surgery provider in Carmel, Indiana, licensed in Indiana (01084888A) and active in the NPI registry since April 2016. He is enrolled in Medicare PECOS, maintains 2 additional practice locations, and is a graduate of Loma Linda University School Of Medicine (2020).

NPPES Registry Identity

NPI1619322898
Entity TypeIndividualMale
Primary Taxonomy207WX0200X
Provider Legal NameDR. JI-KWAN PARKCredential: MD, MPH
Location Address201 PENNSYLVANIA PKWY STE 225Carmel, IN 46280-1399
Mailing Address201 Pennsylvania Pkwy Ste 225Carmel, IN 46280-1399 · (371) 573-1000
Phone(371) 573-1000
Sole ProprietorYes
Medical School CMSLoma Linda University School Of MedicineGraduated 2020
Enumeration DateApril 26, 2016
Last NPPES UpdateApril 21, 20213 updates tracked since enumeration
NPPES CertifiedApril 21, 2021
✔ NPI 1619322898 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 3

★ Primary SpecialtyOphthalmology · Ophthalmic Plastic and Reconstructive SurgeryAllopathic & Osteopathic Physicians
Taxonomy Code207WX0200X
License✔ Licensed in IN · 01084888A
Definition
A physician who specializes in oculofacial plastic and reconstructive surgery. This subspecialty combines orbital and periocular surgery with facial plastic surgery, and includes aesthetic and reconstructive surgery of the face, orbit, eyelid, and lacrimal system. Practitioners evaluate, diagnose and treat conditions involving the eyelids, brows, midface, orbits, lacrimal systems and surrounding and supporting structures of the face and neck.
Also ListedOphthalmologyTaxonomy 207W00000X · License A155176 (CA)
Also ListedStudent in an Organized Health Care Education/Training ProgramTaxonomy 390200000X
201 PENNSYLVANIA PKWY STE 225, Carmel, IN 46280
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Other Names 1

Other Name (5)Dr. Ji Kwan Park Md, Mph

Secondary Practice Locations 2

Location 1555 N 13th AveUpland, CA 91786-4904 · Phone (909) 277-2420 · Fax (909) 206-1097
Location 2333 City Blvd W, Suite 400Orange, CA 92868-2903 · Phone (714) 456-6693

Group Practice 1

Group TaxonomyThis provdier is a business group of one or more individual practitioners, all of who practice with the same area of specialization.193400000X SINGLE SPECIALTY GROUP

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. Ji-kwan Park Md, Mph 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 ID9638590797
PECOS Enrollment IDI20200528002648
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-kwan Park reassigns Medicare billing to 1 organization. The organization bills Medicare for the services this provider delivers there.

Permanente Medical Group Inc
1,885 mi
Internal Medicine
7373 WEST LANE
Stockton, CA 95210
  • Reassigned Medicare billing, California enrollment
  • 20,078 clinicians in this Medicare group
NPI 1548343510 (209) 476-2000

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 46280 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
$122.49 typical visit price
range $53.07 – $161.76
Typical copayment $30.62 (range $13.26 – $40.44)
Most-billed visit code 99204
Established Patient
$66.48 typical visit price
range $16.93 – $132.22
Typical copayment $16.62 (range $4.23 – $33.05)
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.

Medicare Quality Performance CMS QPP · MIPS

Performance in the CMS Quality Payment Program: the MIPS final score across four weighted categories, and the individual quality measures reported to Medicare.

77.59/100
MIPS Final ScoreMerit-based Incentive Payment System · CMS Quality Payment Program
Scored as part of a group practice
Quality100
Improvement Activities40
Cost25.32

Other Providers at the Same Location NPPES

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

MICHAEL MYUNG-SUP HAN MD
Ophthalmology (Ophthalmic Plastic and Reconstructive Surgery)
201 PENNSYLVANIA PKWY STE 225
CARMEL, IN 46280
Hamilton County (317) 573-1000

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-kwan Park's NPI number?

The NPI number for Ji-kwan Park is 1619322898. It was assigned to this individual provider in the NPPES registry on April 26, 2016. The provider is also known as Dr. Ji Kwan Park MD, Mph.

Where is Ji-kwan Park located?

Ji-kwan Park practices at 201 Pennsylvania Pkwy Ste 225, Carmel, IN 46280. The listed phone number is (371) 573-1000.

What is Ji-kwan Park's specialty?

The primary specialty registered for this NPI is Ophthalmology, specializing in Ophthalmic Plastic and Reconstructive Surgery, with taxonomy code 207WX0200X.

Is Ji-kwan Park enrolled in Medicare?

Yes. Ji-kwan 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 organization bills Medicare for Ji-kwan Park's services?

According to the CMS Revalidation Reassignment List (October 2026 release), Ji-kwan Park reassigns Medicare benefits to Permanente Medical Group Inc (Stockton, 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 Ji-kwan 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-kwan Park was last updated on April 21, 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.