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CHAN SOO PARK MD
NPI 1861485484
Psychiatry & Neurology - Neurology in Poughkeepsie, NY

Active since August 30, 2005PECOS Enrolled
205 SOUTH AVE, SUITE 103, POUGHKEEPSIE, NY 12601(845) 454-2360(845) 454-2361 Get Directions Write a Review

NPPES record last updated: July 13, 2026. Verified against the NPPES registry weekly; last sync: October 18, 2026.

About Chan Soo Park Md NPPES

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

CHAN SOO PARK MD (NPI 1861485484) is an individual neurology provider in Poughkeepsie, New York, licensed in New York (127160) and active in the NPI registry since August 2005. He is enrolled in Medicare PECOS.

NPPES Registry Identity

NPI1861485484
Entity TypeIndividualMale
Primary Taxonomy2084N0400X
Provider Legal NameCHAN SOO PARKCredential: MD
Location Address205 SOUTH AVE, SUITE 103Poughkeepsie, NY 12601-4818
Mailing Address205 South Ave, Suite 103Poughkeepsie, NY 12601-4818 · (845) 454-2360 · Fax (845) 454-2361
Phone(845) 454-2360
Fax(845) 454-2361
Sole ProprietorNo
Enumeration DateAugust 30, 2005
Last NPPES UpdateJuly 13, 2026
✔ NPI 1861485484 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyPsychiatry & Neurology · NeurologyAllopathic & Osteopathic Physicians
Taxonomy Code2084N0400X
License✔ Licensed in NY · 127160
Definition
A Neurologist specializes in the diagnosis and treatment of diseases or impaired function of the brain, spinal cord, peripheral nerves, muscles, autonomic nervous system, and blood vessels that relate to these structures.
205 SOUTH AVE, Poughkeepsie, NY 12601
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Other Identifiers 1

Medicaid00503613NY

Medicare Participation & PECOS CMS

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

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Chan Soo Park Md 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 Reassignment

Medicare enrollment records show Chan Soo Park reassigns Medicare billing to 1 organization. The organization bills Medicare for the services this provider delivers there.

State Of New York Comptrollers Office
26 mi
Developmental Disabilities
1620 TOWN CENTER ROUTE 22
Brewster, NY 10509
  • Reassigned Medicare billing, New York enrollment
  • 342 clinicians in this Medicare group
NPI 1043335284 (845) 279-2905

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 12601 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
$141.77 typical visit price
range $61.88 – $187.05
Typical copayment $35.44 (range $15.47 – $46.76)
Most-billed visit code 99204
Established Patient
$108.56 typical visit price
range $19.92 – $151.94
Typical copayment $27.14 (range $4.98 – $37.98)
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.

MARY DESARIO MSW
Social Worker
205 SOUTH AVE
POUGHKEEPSIE, NY 12601
Dutchess County (845) 554-1365
KARA ANN CANNELLI
Counselor (Mental Health)
205 SOUTH AVE
POUGHKEEPSIE, NY 12601
Dutchess County (845) 485-4680
KRISTIN WOODS
Counselor (Mental Health)
205 SOUTH AVE
POUGHKEEPSIE, NY 12601
Dutchess County (845) 554-1365
MEGAN RAE YORK MHC
Counselor (Mental Health)
205 SOUTH AVE, SUITE 105
POUGHKEEPSIE, NY 12601
Dutchess County (845) 554-1365
DR. JOYCE FRALEIGH DITTENHOEFER AUD
Audiologist
205 SOUTH AVE, SUITE 202
POUGHKEEPSIE, NY 12601
Dutchess County (845) 485-0179
LYNDSEY DUSSLING LMSW
Social Worker
205 SOUTH AVE
POUGHKEEPSIE, NY 12601
Dutchess County (845) 554-1365
MS. WHITNEY ALEXANDRA GARRITT MSW
Social Worker
205 SOUTH AVE
POUGHKEEPSIE, NY 12601
Dutchess County (845) 554-1365
DR. JEFFREY ALAN SAFFIR DC
Chiropractor
205 SOUTH AVE, SUITE 107
POUGHKEEPSIE, NY 12601
Dutchess County (845) 485-5656

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 Chan Soo Park's NPI number?

The NPI number for Chan Soo Park is 1861485484. It was assigned to this individual provider in the NPPES registry on August 30, 2005.

Where is Chan Soo Park located?

Chan Soo Park practices at 205 South Ave Suite 103, Poughkeepsie, NY 12601. The listed phone number is (845) 454-2360.

What is Chan Soo Park's specialty?

The primary specialty registered for this NPI is Psychiatry & Neurology, specializing in Neurology, with taxonomy code 2084N0400X.

Is Chan Soo Park enrolled in Medicare?

Yes. Chan Soo Park is registered in the Medicare PECOS enrollment system.

Which organization bills Medicare for Chan Soo Park's services?

According to the CMS Revalidation Reassignment List (October 2026 release), Chan Soo Park reassigns Medicare benefits to State Of New York Comptrollers Office (Brewster, 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 Chan Soo 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 Chan Soo Park was last updated on July 13, 2026. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 3 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.