Lisa Park, is a medicare enrolled "Colon & Rectal Surgery" physician in Larkspur, California. She went to Albany Medical College Of Union University and graduated in 2015 and has 9 years of diverse experience with area of expertise as Colorectal Surgery (proctology). She is a member of the group practice Regents Univ Of California Ucsf and her current practice location is
5 Bon Air Rd Ste 101, Larkspur, California. You can reach out to her office (for appointments etc.) via phone at
(415) 924-2515.
Lisa Park is licensed to practice in California (license number A168789) and she also participates in the medicare program. She
may accept medicare assignments (which means she may accept the Medicare-approved amount; you may be billed for more than the Medicare deductible and coinsurance) and her NPI Number is 1568857142.
Physician's Profile
| Full Name | Lisa Park |
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| Gender | Female |
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| Speciality | Colorectal Surgery (proctology) |
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| Experience | 9 Years |
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| Location | 5 Bon Air Rd Ste 101, Larkspur, California |
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| Accepts Medicare Assignments | May be. She may accept the Medicare-approved amount; you may be billed for more than the Medicare deductible and coinsurance. |
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Medical Education and Training:
- Lisa Park attended and graduated from Albany Medical College Of Union University in 2015
NPI Data:
- NPI Number: 1568857142
- Provider Enumeration Date: 04/01/2015
- Last Update Date: 12/03/2021
Medicare PECOS Information:
- PECOS PAC ID: 0547561557
- Enrollment ID: I20211201003030
Medical Identifiers
Medical identifiers for Lisa Park such as npi, medicare ID, medicare PIN, medicaid, etc.
| Identifier | Type | State | Issuer |
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| 1568857142 | NPI | - | NPPES |
Medical Taxonomies and Licenses
| Taxonomy | Type | License (State) | Status |
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| 208600000X | Surgery | 57.027085 (Ohio) | Secondary |
| 208C00000X | Colon & Rectal Surgery | A168789 (California) | Primary |
Medical Facilities Affiliation
Group Practice Association
| Group Practice Name | Group PECOS PAC ID | No. of Members |
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| Regents Univ Of California Ucsf | 6305160300 | 216 |
Medicare Reassignments
Some practitioners may not bill the customers directly but medicare billing happens through clinics / group practice / hospitals where the provider works. Medicare reassignment of benefits is a mechanism by which practitioners allow third parties to bill and receive payment for medicare services performed by them. Lisa Park allows following entities to bill medicare on her behalf.
| Entity Name | Regents Univ Of California Ucsf |
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| Entity Type | Part B Supplier - Clinic/group Practice |
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| Entity Identifiers | NPI Number: 1124439807
PECOS PAC ID: 6305160300
Enrollment ID: O20150122001375 |
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Medicare Part D Prescriber Enrollment
Any physician or other eligible professional who prescribes Part D drugs must either enroll in the Medicare program or opt out in order to prescribe drugs to their patients with Part D prescription drug benefit plans. Lisa Park is
enrolled with medicare and thus, if eligible, can prescribe medicare part D drugs to patients with medicare part D benefits.
Mailing Address and Practice Location
| Mailing Address | Practice Location Address |
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Lisa Park,
5 Bon Air Rd Ste 101,
Larkspur, CA 94939-1134
Ph: (415) 924-2515 | Lisa Park,
5 Bon Air Rd Ste 101,
Larkspur, CA 94939-1134
Ph: (415) 924-2515 |
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