Physician Compare National (NPI:1316980295)

HEALTHCARE PROVIDER: KEN PARK M.D.

Physician Compare National contains general information about individual eligible professionals (EPs) such as demographic information and Medicare quality program participation.

Individual Professional Information
NPI	1316980295
	Unique healthcare provider (clinician) ID assigned by NPPES
PECOS UID	2466582028
	Unique individual clinician ID assigned by PECOS
Professional Enrollment ID	I20111215000787
	Unique ID for the individual professional enrollment that is the source for the data in the observation
Provider Last Name	PARK
	Individual professional last name
Provider First Name	KEN
	Individual professional first name
Provider Gender	M
	The provider's gender if the provider is a person.

Medical School Information
Medical School Name	UNIVERSITY OF TEXAS MEDICAL BRANCH AT GALVESTON
	Individual professional's medical school
Graduation Year	1998
	Individual professional's medical school graduation year
Primary Specialty	INTERNAL MEDICINE
	Primary medical specialty reported by the individual professional in the selected enrollment

Practice Information
Organization Legal Name	MD ON CALL PA
	Legal name of the Group Practice that the individual professional works with- will be blank if the address is not linked to a Group Practice
Group Practice PAC ID	2264402874
	Unique Group Practice ID assigned by PECOS to the Group Practice that the individual professional works with- will be blank if the address is not linked to a Group Practice
Number of Group Practice members	9
	Total number of individual professionals affiliated with the Group Practice based on Group Practice PAC ID
Line 1 Street Address	2990 LEGACY DR
	Group Practice or individual's line 1 address
City	FRISCO
	Group Practice or individual's city
State	TX
	Group Practice or individual's state
Zip Code	750346066
	Group Practice or individual's zip code (9 digits when available)
Phone Number	2142216362
	Phone number is listed only when there is a single phone number available for the practice location address

Hospital(s) Affiliation Information
Hospital Affiliation CCN 1	450771
	Medicare CCN of hospital where individual professional provides service 1
Hospital Affiliation LBN 1	TEXAS HEALTH PRESBYTERIAN HOSPITAL PLANO
	Legal business name of hospital where individual professional provides service 1
Professional Accepts Medicare Assignment	Y