SHANE PARK CRNA
NPI 1629520127
Nurse Anesthetist, Certified Registered in Oro Valley, AZ

Q: What is Shane Park's NPI number?

The NPI number for Shane Park is 1629520127. It was assigned to this individual provider in the NPPES registry on October 31, 2016.

Q: What is Shane Park's specialty?

The primary specialty registered for this NPI is Nurse Anesthetist, Certified Registered with taxonomy code 367500000X.

Q: When was this NPI record last updated?

The NPPES record for Shane Park was last updated on April 28, 2025. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 17 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.

Active since October 31, 2016Accepts Medicare Assignment

1551 E TANGERINE RD, ORO VALLEY, AZ 85755(520) 901-3500 Get Directions Write a Review

NPPES record last updated: April 28, 2025. Verified against the NPPES registry weekly; last sync: October 25, 2026.

Record update history: Nov 18, 2016, Oct 31, 2016 (2 updates tracked since 2016).

On this page

About Shane Park Crna NPPES

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

SHANE PARK CRNA (NPI 1629520127) is an individual nurse anesthetist, certified registered in Oro Valley, Arizona, licensed in Arizona (233774) and active in the NPI registry since October 2016. He maintains a secondary practice location in Loma Linda and is a graduate of Other (2016).

NPPES Registry Identity

NPI1629520127

Entity TypeIndividualMale

Primary Taxonomy367500000X

Provider Legal NameSHANE PARKCredential: CRNA

Location Address1551 E TANGERINE RDOro Valley, AZ 85755-6213

Mailing Address11234 Anderson StLoma Linda, CA 92354-2804 · (213) 700-0178

Phone(520) 901-3500

Sole ProprietorYes

Medical School CMSOtherGraduated 2016

Enumeration DateOctober 31, 2016

Last NPPES UpdateApril 28, 20252 updates tracked since enumeration

NPPES CertifiedApril 28, 2025

✔ NPI 1629520127 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyNurse Anesthetist, Certified RegisteredPhysician Assistants & Advanced Practice Nursing Providers

Taxonomy Code367500000X

Licenses✔ Licensed in AZ · 233774✔ Licensed in CA · 95000619

Definition

(1) A licensed registered nurse with advanced specialty education in anesthesia who, in collaboration with appropriate health care professionals, provides preoperative, intraoperative, and postoperative care to patients and assists in management and resuscitation of critical patients in intensive care, coronary care, and emergency situations. Nurse anesthetists are certified following successful completion of credentials and state licensure review and a national examination directed by the Council on Certification of Nurse Anesthetists. (2) A registered nurse who is qualified by special training to administer anesthesia in collaboration with a physician or dentist and who can assist in the care of patients who are in critical condition.

1551 E TANGERINE RD, Oro Valley, AZ 85755

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Secondary Practice Location 1

Location 111234 Anderson StreetLoma Linda, CA 92354 · Phone (213) 700-0178

Accepted Insurance

The full list of accepted plans is on the Insurance tab. Issuers include Blue Cross Blue Shield of Arizona.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

Shane Park Crna 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 ID749560761

PECOS Enrollment IDI20231108002123

Medicare Billing Reassignments

Medicare enrollment records show Shane Park reassigns Medicare billing to 2 organizations. Each organization bills Medicare for the services this provider delivers there; the nearest is listed first.

Northwest Hbp Medical Services LLC

8.3 mi

Emergency Medicine

6200 N LA CHOLLA BLVD
Tucson, AZ 85741

Reassigned Medicare billing, Arizona enrollment
664 clinicians in this Medicare group

NPI 1407353006 (520) 229-2657

Ias Arizona PLLC

13 mi

Anesthesiology

5301 E GRANT RD
Tucson, AZ 85712

Reassigned Medicare billing, Arizona enrollment
264 clinicians in this Medicare group

NPI 1689359747 (520) 327-5461

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 85755 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

$127.71 typical visit price

range $55.44 – $168.60

Typical copayment $31.92 (range $13.86 – $42.15)

Most-billed visit code 99204

Established Patient

$69.24 typical visit price

range $17.72 – $137.41

Typical copayment $17.31 (range $4.43 – $34.35)

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.

AUSTRALIAN HERRING INPATIENT SERVICES LLC

Internal Medicine