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SHAUN PARK M.D.
NPI 1780974212
Pediatrics in Loma Linda, CA

Active since April 18, 2011PECOS Enrolled
11175 CAMPUS ST, CP-A1121, LOMA LINDA, CA 92350(909) 558-8142 Get Directions Write a Review

NPPES record last updated: January 13, 2023. Verified against the NPPES registry weekly; last sync: October 25, 2026.

About Shaun Park M.d. NPPES

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

SHAUN PARK M.D. (NPI 1780974212) is an individual pediatrics provider in Loma Linda, California, licensed in California (A122388) and active in the NPI registry since April 2011. He is enrolled in Medicare PECOS.

NPPES Registry Identity

NPI1780974212
Entity TypeIndividualMale
Primary Taxonomy208000000X
Provider Legal NameSHAUN PARKCredential: M.D.
Location Address11175 CAMPUS ST, CP-A1121Loma Linda, CA 92350-1700
Mailing Address54701 File NumberLos Angeles, CA 90074-4701 · (909) 558-3311
Phone(909) 558-8142
Sole ProprietorNo
Enumeration DateApril 18, 2011
Last NPPES UpdateJanuary 13, 2023
✔ NPI 1780974212 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyPediatricsAllopathic & Osteopathic Physicians
Taxonomy Code208000000X
License✔ Licensed in CA · A122388
Definition
A pediatrician is concerned with the physical, emotional and social health of children from birth to young adulthood. Care encompasses a broad spectrum of health services ranging from preventive healthcare to the diagnosis and treatment of acute and chronic diseases. A pediatrician deals with biological, social and environmental influences on the developing child, and with the impact of disease and dysfunction on development.
11175 CAMPUS ST, Loma Linda, CA 92350
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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)

Shaun Park M.d. 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 Reassignments

3

Medicare enrollment records show Shaun Park reassigns Medicare billing to 3 organizations. Each organization bills Medicare for the services this provider delivers there; the nearest is listed first.

Faculty Physicians And Surgeons Of Llusm
0.1 mi
Neurology
11234 ANDERSON ST, STE. A233
Loma Linda, CA 92354
  • Reassigned Medicare billing, California enrollment
  • 2,584 clinicians in this Medicare group
NPI 1801016860 (909) 558-2880
Sac Health System
3.6 mi
Federally Qualified Health Center (FQHC)
1454 E 2ND ST
San Bernardino, CA 92408
  • Reassigned Medicare billing, California enrollment
  • 455 clinicians in this Medicare group
NPI 1013935915 (909) 382-7100
Southern California Permanente Medical Group
9.7 mi
Health Maintenance Organization
9961 SIERRA AVE
Fontana, CA 92335
  • Reassigned Medicare billing, California enrollment
  • 5,228 clinicians in this Medicare group
NPI 1689606196 (909) 427-3910

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 92350 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
$91.88 typical visit price
range $59.60 – $179.42
Typical copayment $22.97 (range $14.90 – $44.85)
Most-billed visit code 99203
Established Patient
$104.64 typical visit price
range $19.37 – $146.42
Typical copayment $26.16 (range $4.84 – $36.60)
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.

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.

DR. REX TONG HYUN CHUNG M.D.
Surgery (Surgical Critical Care)
11175 CAMPUS ST, RM 21008
LOMA LINDA, CA 92350
San Bernardino County (909) 558-8131
RITA SHETH MD
Pediatrics (Pediatric Nephrology)
11175 CAMPUS ST
LOMA LINDA, CA 92350
San Bernardino County (909) 558-8242
DARLEY R MAGNO
Student in an Organized Health Care Education/Training Program
11175 CAMPUS ST
LOMA LINDA, CA 92350
San Bernardino County (909) 558-4462
DR. DAVID CABA MOLINA M.D, MS, MPH
Surgery (Surgical Oncology)
11175 CAMPUS ST
LOMA LINDA, CA 92350
San Bernardino County (909) 558-5939
MANJOT KAUR PA-C
Physician Assistant
11175 CAMPUS ST
LOMA LINDA, CA 92350
San Bernardino County (909) 558-1000
DR. KRISTEN ANNE HUGHES M.D.
Pediatrics
11175 CAMPUS ST, SUITE 11120
LOMA LINDA, CA 92350
San Bernardino County (909) 558-4000
RITA ARTOUNIAN MILAGERDI
Physician Assistant
11175 CAMPUS ST
LOMA LINDA, CA 92350
San Bernardino County (909) 558-4000
PROF. GINA DELIA ROQUE TORRES DDS
Clinic/Center (Dental)
11175 CAMPUS ST
LOMA LINDA, CA 92350
San Bernardino County (909) 558-5933

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 Shaun Park's NPI number?

The NPI number for Shaun Park is 1780974212. It was assigned to this individual provider in the NPPES registry on April 18, 2011.

Where is Shaun Park located?

Shaun Park practices at 11175 Campus St Cp-A1121, Loma Linda, CA 92350. The listed phone number is (909) 558-8142.

What is Shaun Park's specialty?

The primary specialty registered for this NPI is Pediatrics with taxonomy code 208000000X.

Is Shaun Park enrolled in Medicare?

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

Which organizations bill Medicare for Shaun Park's services?

According to the CMS Revalidation Reassignment List (October 2026 release), Shaun Park reassigns Medicare benefits to 3 organizations: Faculty Physicians And Surgeons Of Llusm (Loma Linda, CA), Sac Health System (San Bernardino, CA) and Southern California Permanente Medical Group (Fontana, CA). Each 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 Shaun 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 Shaun Park was last updated on January 13, 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.