SE HUN PARK (ATC) – Physician Assistant, NPI 1356717789
Physician Assistant
Main info
Doctor Profile
Profile Insights
NPPES metrics only — not quality of care.
1,853 PHYSICIAN ASSISTANT in MO
Provider Addresses for SE HUN PARK (ATC)
2135 S FREMONT AVE
SPRINGFIELD, MO 658042239
Phone: (417) 820-7990
Type: Mailing
901 S NATIONAL AVE
SPRINGFIELD, MO 658970027
Phone: (417) 836-8553
Type: Location
3401 W GORE BLVD
LAWTON, OK 735056332
Phone: (580) 355-8620
Type: Mailing
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 $249.
Total Amount is formed as General ($249) + Research ($0) + Ownership ($0) = $249.
Last reported payment date: 2024-09-18 • Largest payer in this snapshot: Axsome Therapeutics, Inc. ($125).
Total Amount
$249
General + Research + Ownership
Payments
2
Total payment records
General Amount
$249
General payments
Research Amount
$0
Research funding
Ownership Amount
$0
Ownership interests
Ownership Count
0
Ownership records
Last Payment Date
2024-09-18
Latest reported date
Top Companies
Largest payers in this snapshot
| Company | Amount |
|---|---|
| Axsome Therapeutics, Inc. | $125 |
| Phathom Pharmaceuticals, Inc. | $124 |
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: 2025-01-22
PECOS data refreshed: 2026-05-27
Medicare revalidation (CMS due date list)
Due date not assigned yet
CMS is tracking 3 Medicare enrollment records; no due dates published yet.
Enrollment records
3
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 |
|---|---|---|---|---|
| I20240309000190 | I | Physician Assistant | MO | TBD |
| I20241220002342 | I | Physician Assistant | TX | TBD |
| I20250122001168 | I | Physician Assistant | OK | 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 65804)
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Group practice members
| Name | Specialty | State |
|---|---|---|
| Nurse Practitioner | WI | |
| Emergency Medicine | TX | |
| Physician Assistant | OK | |
| Emergency Medicine | CA | |
| Physician Assistant | OK | |
| Physician Assistant | OK | |
| Physician Assistant | OK | |
| Physician Assistant | OK | |
| Physician Assistant | OK | |
| Emergency Medicine | ID |
Reviews
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