Russell Dean Park, PHD - Medicare Psychologist in Jamestown, CA

Russell Dean Park, PHD is a medicare enrolled "Psychologist - Clinical" provider in Jamestown, California. His current practice location is 5100 O'byrnes Ferry Rd., Jamestown, California. You can reach out to his office (for appointments etc.) via phone at (209) 984-5291.

Russell Dean Park is licensed to practice in California (license number PSY14275) 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 1326020710.

Contact Information

Russell Dean Park, PHD
5100 O'byrnes Ferry Rd.,
Jamestown, CA 95327
(209) 984-5291
Not Available



Healthcare Provider's Profile

Full NameRussell Dean Park
GenderMale
SpecialityPsychologist - Clinical
Location5100 O'byrnes Ferry Rd., Jamestown, California
Accepts Medicare AssignmentsMedicare enrolled and may accept medicare through third-party reassignment. May prescribe medicare part D drugs.
  NPI Data:
  • NPI Number: 1326020710
  • Provider Enumeration Date: 11/19/2005
  • Last Update Date: 04/04/2013
  Medicare PECOS Information:
  • PECOS PAC ID: 3577598929
  • Enrollment ID: I20051004000906

Medical Identifiers

Medical identifiers for Russell Dean Park such as npi, medicare ID, medicare PIN, medicaid, etc.
IdentifierTypeStateIssuer
1326020710NPI-NPPES

Medical Taxonomies and Licenses

TaxonomyTypeLicense (State)Status
103TC0700XPsychologist - Clinical PSY14275 (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. Russell Dean Park allows following entities to bill medicare on his behalf.
Entity NameMemory Check Psychological Services, A Professional Corporation
Entity TypePart B Supplier - Clinic/group Practice
Entity IdentifiersNPI Number: 1912184219
PECOS PAC ID: 7416856422
Enrollment ID: O20040107001021

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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. Russell Dean 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 AddressPractice Location Address
Russell Dean Park, PHD
Po Box 215,
Monte Rio, CA 95462-0215

Ph: (209) 380-3932
Russell Dean Park, PHD
5100 O'byrnes Ferry Rd.,
Jamestown, CA 95327

Ph: (209) 984-5291

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Psychologist in Jamestown, CA

Dr. Minou Alexander, PHD
Psychologist
Medicare: Not Enrolled in Medicare
Practice Location: 5100 O'byrner Ferry Rd., Sierra Conservation Center, Jamestown, CA 95327
Phone: 209-984-5291    Fax: 209-984-8587
Mr. Richard Perry Halliburton, PSYD
Psychologist
Medicare: Not Enrolled in Medicare
Practice Location: 5100 Obyrnes Ferry Rd, Jamestown, CA 95327
Phone: 209-984-5291    
Dr. Katherine Jean Robertson, PH.D.
Psychologist
Medicare: Not Enrolled in Medicare
Practice Location: 5100 Obyrnes Ferry Rd, Jamestown, CA 95327
Phone: 209-984-5291    
Dr. Michael A Backlund, PHD
Psychologist
Medicare: Not Enrolled in Medicare
Practice Location: 5100 O Brynes Ferry Rd, Jamestown, CA 95327
Phone: 209-984-5291    

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