DR. JAY SUNG PARK (D.O.) – Diagnostic Radiology Physician, NPI 1639167877
Diagnostic Radiology Physician
Main info
Doctor Profile
Profile Insights
NPPES metrics only — not quality of care.
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Provider Addresses for DR. JAY SUNG PARK (D.O.)
1600, Lakeland Hills Boulevard, Lakeland, Polk County, Florida, 33805, United States
LAKELAND, FL 338053019
Phone: (863) 680-7000
Fax: (866) 264-8519
Type: Mailing
15790 Paul Vega Md Dr
Hammond, LA 704031436
Phone: (985) 345-2700
Fax: (985) 230-6652
Type: Location
NPPES updates history
No NPPES updates recorded for this provider.
Prescription Activity
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Open Payments (CMS)
CMS reports 2 Open Payments records for all available years, with a total value of $58.
Total Amount is formed as General ($58) + Research ($0) + Ownership ($0) = $58.
Last reported payment date: 2024-11-19 • Largest payer in this snapshot: Zap Surgical Systems, Inc. ($36).
Total Amount
$58
General + Research + Ownership
Payments
2
Total payment records
General Amount
$58
General payments
Research Amount
$0
Research funding
Ownership Amount
$0
Ownership interests
Ownership Count
0
Ownership records
Last Payment Date
2024-11-19
Latest reported date
Top Companies
Largest payers in this snapshot
| Company | Amount |
|---|---|
| Zap Surgical Systems, Inc. | $36 |
| REVANCE THERAPEUTICS, INC. | $22 |
Medicare Enrollment & Revalidation
Source: CMS public data · Not endorsed by CMS ·
Educational use only—not medical, billing, or legal advice.
PECOS enrollment status
Participating (accepts Medicare assignment)
Enrollment effective: 2015-08-10
PECOS data refreshed: 2026-05-27
Medicare revalidation (CMS due date list)
Due date not assigned yet
CMS is tracking this Medicare enrollment for revalidation, but has not published a due date.
Enrollment records
1
Earliest due date
Not assigned (TBD)
CMS data updated
2026-06-01
Revalidation progress
- Medicare enrolled
- On CMS revalidation list
- Due date assigned
- Revalidate in PECOS
CMS enrollment records
| Enrollment ID | Type | Specialty | State | Due date |
|---|---|---|---|---|
| I20150810003000 | I | Diagnostic Radiology | FL | TBD |
What to do next
- No action required while the due date shows TBD.
- Check the CMS Revalidation Lookup Tool periodically — CMS updates the list about every 60 days.
- Do not submit a revalidation application in PECOS until CMS publishes a concrete due date.
Prepare CMS-855 application → · Look up this NPI in PECOS → · Verify on CMS PECOS
Medicare Utilization (FFS)
Source: CMS public data · Not endorsed by CMS · Beneficiary counts under 11 are suppressed in source data ·
Educational use only—not medical, billing, or legal advice.
No Medicare fee-for-service utilization data available for this provider in our database.
Insurance plans in this area (ZIP 33805)
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Group practice members
| Name | Specialty | State |
|---|---|---|
| Cardiovascular Disease (Cardiology) | NJ | |
| - | NC | |
| Diagnostic Radiology | CA | |
| - | NV | |
| - | FL | |
| Diagnostic Radiology | AZ | |
| Interventional Radiology, Diagnostic Radiology | IL | |
| - | PR | |
| Diagnostic Radiology | IL | |
| Diagnostic Radiology | AZ |
Reviews
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