Lisa Marie Park, FNP-BC is a medicare enrolled "Family Medicine" physician in Triadelphia, West Virginia. She graduated from medical school in 2023 and has 3 years of diverse experience with area of expertise as Nurse Practitioner. She is a member of the group practice Wmc Physician Practices Llc and her current practice location is
4509 National Rd, Triadelphia, West Virginia. You can reach out to her office (for appointments etc.) via phone at
(304) 639-0873.
Lisa Marie Park is licensed to practice in West Virginia (license number 117804) and she also participates in the medicare program. She
accepts medicare assignments (which means she accepts the Medicare-approved amount; you will not be billed for any more than the Medicare deductible and coinsurance) and her NPI Number is 1639944382.
Physician's Profile
| Full Name | Lisa Marie Park |
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| Gender | Female |
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| Speciality | Nurse Practitioner |
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| Experience | 3 Years |
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| Location | 4509 National Rd, Triadelphia, West Virginia |
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| Accepts Medicare Assignments | Yes. She accepts the Medicare-approved amount; you will not be billed for any more than the Medicare deductible and coinsurance. |
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Medical Education and Training:
- Lisa Marie Park graduated from medical school in 2023
NPI Data:
- NPI Number: 1639944382
- Provider Enumeration Date: 11/21/2023
- Last Update Date: 11/21/2023
Medicare PECOS Information:
- PECOS PAC ID: 0042660730
- Enrollment ID: I20231220004092
Medical Identifiers
Medical identifiers for Lisa Marie Park such as npi, medicare ID, medicare PIN, medicaid, etc.
| Identifier | Type | State | Issuer |
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| 1639944382 | NPI | - | NPPES |
Medical Taxonomies and Licenses
| Taxonomy | Type | License (State) | Status |
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| 207Q00000X | Family Medicine | 117804 (West Virginia) | Primary |
Medical Facilities Affiliation
Group Practice Association
| Group Practice Name | Group PECOS PAC ID | No. of Members |
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| Wmc Physician Practices Llc | 0244466753 | 98 |
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 Marie Park allows following entities to bill medicare on her behalf.
| Entity Name | Wmc Physician Practices Llc |
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| Entity Type | Part B Supplier - Clinic/group Practice |
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| Entity Identifiers | NPI Number: 1518303288
PECOS PAC ID: 0244466753
Enrollment ID: O20131111001065 |
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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 Marie 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 Marie Park, FNP-BC
Po Box 285,
Triadelphia, WV 26059-0285
Ph: (304) 639-0873 | Lisa Marie Park, FNP-BC
4509 National Rd,
Triadelphia, WV 26059-2013
Ph: (304) 639-0873 |
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