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LIDIA PARK
NPI 1851927867
Pediatrics in Lodi, CA

Active since March 21, 2020PECOS Enrolled
975 S FAIRMONT AVE, LODI, CA 95240(209) 334-3411 Get Directions Write a Review

NPPES record last updated: July 10, 2023. Verified against the NPPES registry weekly; last sync: October 18, 2026.

Record update history: Jul 10, 2023, Mar 21, 2020 (2 updates tracked since 2020).

About Lidia Park NPPES

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

LIDIA PARK (NPI 1851927867) is an individual pediatrics provider in Lodi, California, licensed in California (182789) and active in the NPI registry since March 2020. She is enrolled in Medicare PECOS.

NPPES Registry Identity

NPI1851927867
Entity TypeIndividualFemale
Primary Taxonomy208000000X
Provider Legal NameLIDIA PARK
Location Address975 S FAIRMONT AVELodi, CA 95240-5118
Mailing Address3819 Roseparke WaySacramento, CA 95834-2083
Phone(209) 334-3411
Sole ProprietorNo
Enumeration DateMarch 21, 2020
Last NPPES UpdateJuly 10, 20232 updates tracked since enumeration
NPPES CertifiedJuly 10, 2023
✔ NPI 1851927867 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyPediatricsAllopathic & Osteopathic Physicians
Taxonomy Code208000000X
License✔ Licensed in CA · 182789
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.
975 S FAIRMONT AVE, Lodi, CA 95240
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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)

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

Permanente Medical Group Inc
7.1 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
Regents Of The Univ Of Ca
31 mi
Clinical Child & Adolescent
2825 50TH ST
Sacramento, CA 95817
  • Reassigned Medicare billing, California enrollment
  • 2,570 clinicians in this Medicare group
NPI 1447423959 (916) 703-0315
Sutter Valley Medical Foundation
36 mi
Multi-Specialty
2700 GATEWAY OAKS DR
Sacramento, CA 95833
  • Reassigned Medicare billing, California enrollment
  • 3,056 clinicians in this Medicare group
NPI 1952327256 (800) 470-0071

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 95240 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
$90.32 typical visit price
range $58.87 – $176.60
Typical copayment $22.58 (range $14.71 – $44.15)
Most-billed visit code 99203
Established Patient
$103.36 typical visit price
range $19.28 – $144.60
Typical copayment $25.84 (range $4.82 – $36.15)
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.

TERI SPRING RD
Dietitian, Registered
975 S FAIRMONT AVE
LODI, CA 95240
San Joaquin County (209) 334-3411
DIAGNOSTIC PATHOLOGY MEDICAL GROUP INC
Pathology (Anatomic Pathology & Clinical Pathology)
975 S FAIRMONT AVE
LODI, CA 95240
San Joaquin County (916) 447-6267
DR. KEVIN EARL RABEY M.D.
Emergency Medicine
975 S FAIRMONT AVE
LODI, CA 95240
San Joaquin County (209) 334-3411
ARIANNA BUSH
Physician Assistant
975 S FAIRMONT AVE
LODI, CA 95240
San Joaquin County (209) 334-3411
LODI MEMORIAL HOSPTIAL PHARMACY WEST
Pharmacy (Clinic Pharmacy)
975 S FAIRMONT AVE, 2415 W VINE #104
LODI, CA 95240
San Joaquin County (209) 334-3411
MRS. KRISTINA FORTES FNP, MSN, RN
Nurse Practitioner (Family)
975 S FAIRMONT AVE
LODI, CA 95240
San Joaquin County (209) 334-3411
ADAM JOSEPH WOODYARD DO
Radiology (Diagnostic Radiology)
975 S FAIRMONT AVE
LODI, CA 95240
San Joaquin County (209) 334-3411
LANCY LU
Pediatrics
975 S FAIRMONT AVE
LODI, CA 95240
San Joaquin County (209) 339-7639

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 Lidia Park's NPI number?

The NPI number for Lidia Park is 1851927867. It was assigned to this individual provider in the NPPES registry on March 21, 2020.

Where is Lidia Park located?

Lidia Park practices at 975 S Fairmont Ave, Lodi, CA 95240. The listed phone number is (209) 334-3411.

What is Lidia Park's specialty?

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

Is Lidia Park enrolled in Medicare?

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

Which organizations bill Medicare for Lidia Park's services?

According to the CMS Revalidation Reassignment List (October 2026 release), Lidia Park reassigns Medicare benefits to 3 organizations: Permanente Medical Group Inc (Stockton, CA), Regents Of The Univ Of Ca (Sacramento, CA) and Sutter Valley Medical Foundation (Sacramento, 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 Lidia 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 Lidia Park was last updated on July 10, 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.