JAE O PARK (MD) – Internal Medicine Physician, NPI 1780621805
Internal Medicine Physician
Main info
Doctor Profile
Profile Insights
NPPES metrics only — not quality of care.
2,475 INTERNAL MEDICINE in OR
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Provider Addresses for JAE O PARK (MD)
12750, Southwest 2nd Street, Central Beaverton, Beaverton, Metro, Washington County, Oregon, 97005, United States
STE 101
BEAVERTON, OR 970052779
Phone: (503) 643-2120
Fax: (503) 643-1034
Type: Mailing
Dr. Lili Acupuncture, 14455, Southwest Allen Boulevard, Central Beaverton, Beaverton, Washington County, Oregon, 97005, United States
SUITE 101
BEAVERTON, OR 970054428
Phone: (503) 643-2120
Fax: (503) 643-1034
Type: Location
NPPES updates history
No NPPES updates recorded for this provider.
Prescription Activity
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Open Payments (CMS)
CMS reports 1 Open Payments records for all available years, with a total value of $20.
Total Amount is formed as General ($20) + Research ($0) + Ownership ($0) = $20.
Last reported payment date: 2023-02-24 • Largest payer in this snapshot: Abbott Laboratories ($20).
Total Amount
$20
General + Research + Ownership
Payments
1
Total payment records
General Amount
$20
General payments
Research Amount
$0
Research funding
Ownership Amount
$0
Ownership interests
Ownership Count
0
Ownership records
Last Payment Date
2023-02-24
Latest reported date
Top Companies
Largest payers in this snapshot
| Company | Amount |
|---|---|
| Abbott Laboratories | $20 |
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: 2012-02-28
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 |
|---|---|---|---|---|
| I20120228000765 | I | Internal Medicine | OR | 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.
Top Medicare procedures (2023) · refreshed 2026-05-27
| HCPCS | Description | Services | Beneficiaries | Medicare allowed |
|---|---|---|---|---|
| 99214 | Established patient office or other outpatient visit, 30-39 minutes | 113 | 46 | $0 |
| 36410 | Insertion of needle into vein (3 years or older) | 95 | 45 | $0 |
| 99213 | Established patient office or other outpatient visit, 20-29 minutes | 21 | 17 | $0 |
| 90674 | Influenza vaccine, quadrivalent derived from cell cultures, preservative and antibiotic free | 16 | 16 | $0 |
| G0008 | Administration of influenza virus vaccine | 16 | 16 | $0 |
Insurance plans in this area (ZIP 97005)
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