Shane Park, CRNA in Loma Linda, CA - Medicare Nurse Anesthetist, Certified Registered

Shane Park, CRNA is a medicare enrolled "Nurse Anesthetist, Certified Registered" in Loma Linda, California. His current practice location is 11234 Anderson Street, Loma Linda, California. You can reach out to his office (for appointments etc.) via phone at (213) 700-0178.

Shane Park is licensed to practice in California (license number 95000619) and he also participates in the medicare program. He does not accept medicare assignments directly but he may accept medicare through third-party (refer to Reassignment section below) and may also prescribe medicare part D drugs. His NPI Number is 1629520127.

Contact Information

	Shane Park, CRNA
	11234 Anderson Street, Loma Linda, CA 92354
	(213) 700-0178
	Not Available

Map and Direction

Provider's Profile

Full Name	Shane Park
Gender	Male
Speciality	Nurse Anesthetist, Certified Registered
Location	11234 Anderson Street, Loma Linda, California
Accepts Medicare Assignments	Medicare enrolled and may accept medicare through third-party reassignment. May prescribe medicare part D drugs.

NPI Data:

NPI Number: 1629520127
Provider Enumeration Date: 10/31/2016
Last Update Date: 11/18/2016

Medicare PECOS Information:

PECOS PAC ID: 0749560761
Enrollment ID: I20231108002123

Medical Identifiers

Medical identifiers for Shane Park such as npi, medicare ID, medicare PIN, medicaid, etc.

Identifier	Type	State	Issuer
1629520127	NPI	-	NPPES

Medical Taxonomies and Licenses

Taxonomy	Type	License (State)	Status
367500000X	Nurse Anesthetist, Certified Registered	95000619 (California)	Primary

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. Shane Park allows following entities to bill medicare on his behalf.

Entity Name	Ias Arizona Pllc
Entity Type	Part B Supplier - Clinic/group Practice
Entity Identifiers	NPI Number: 1689359747 PECOS PAC ID: 7517312648 Enrollment ID: O20231010003129

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. Shane 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
Shane Park, CRNA 11234 Anderson St, Loma Linda, CA 92354-2804 Ph: (213) 700-0178	Shane Park, CRNA 11234 Anderson Street, Loma Linda, CA 92354 Ph: (213) 700-0178

Reviews and Comments

Nurse Anesthetist, Certified Registered Nurses in Loma Linda, CA

Joseph M Wilkinson, CRNA Nurse Anesthetist - CR Medicare: Not Enrolled in Medicare Practice Location: 11234 Anderson St, Loma Linda, CA 92354 Phone: 909-558-4475
Kurt Dieter Cao, C.R.N.A. Nurse Anesthetist - CR Medicare: Accepting Medicare Assignments Practice Location: 11234 Anderson St, Loma Linda, CA 92354 Phone: 909-558-8173
Edwin E Dupper, CRNA Nurse Anesthetist - CR Medicare: Not Enrolled in Medicare Practice Location: 11234 Anderson St, Loma Linda, CA 92354 Phone: 909-558-4475
Mr. Jose Kadry Ii, Nurse Anesthetist - CR Medicare: Accepting Medicare Assignments Practice Location: 11234 Anderson St, Loma Linda, CA 92354 Phone: 909-558-7811 Fax: 909-558-4143
Rochelle Antoinette Solorzano, Nurse Anesthetist - CR Medicare: Medicare Enrolled Practice Location: 11234 Anderson St, Loma Linda, CA 92354 Phone: 909-558-7811
Karin Zabel Nercissian, Nurse Anesthetist - CR Medicare: Not Enrolled in Medicare Practice Location: 11201 Benton St, Loma Linda, CA 92357 Phone: 909-825-7084
Bituin Oben, Nurse Anesthetist - CR Medicare: Accepting Medicare Assignments Practice Location: 11234 Anderson St, Loma Linda, CA 92354 Phone: 909-558-7811

Shane Park, CRNA - Medicare Nurse Anesthetist, Certified Registered in Loma Linda, CA