Jack C. Leong MD SC

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

036070436 Issued in IL

Legal business name

JACK C. LEONG MD SC

Practice address

3000 N Cicero Ave
Chicago, IL 60641-5106

Phone

(773) 231-2885

NPI assigned

Mar 27, 2017

Organization subpart

Yes

Parent organization

CICERO PROMPT CARE AND FAMILY MEDICAL CENTERAs reported in NPPES

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Jack C Leong

Title

M.D, S.C.

Phone

(773) 282-3115

Specialties & licenses 5

Addresses

Other identifiers 1

Other names 1

• Jack C. Leong MD SC Doing business as

Electronic endpoints 1

Tax ID family

Jack C Leong MD SC2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

• Jack C Leong MD SC

  • Primary Care Clinic/Center
  • Chicago, IL
  • NPI 1437357480
  NPD tax ID

Locations

Interoperability endpoints

• Direct secure messaging: jleongmd@cpc.azalea.phimailbox.com

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1490572800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1603152000000",
    "number": "1013448448",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3000 N CICERO AVE",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606415106",
            "telephone_number": "773-231-2885"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3000 N CICERO AVE",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606415106",
            "telephone_number": "773-231-2885"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "JACK C. LEONG MD SC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "CICERO PROMPT CARE AND FAMILY MEDICAL CENTER",
        "enumeration_date": "2017-03-27",
        "last_updated": "2020-10-20",
        "certification_date": "2020-10-20",
        "status": "A",
        "authorized_official_last_name": "LEONG",
        "authorized_official_first_name": "JACK",
        "authorized_official_middle_name": "C",
        "authorized_official_title_or_position": "M.D, S.C.",
        "authorized_official_telephone_number": "773-282-3115",
        "authorized_official_name_prefix": "Dr."
    },
    "taxonomies": [
        {
            "code": "207K00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Allergy & Immunology",
            "state": "IL",
            "license": "036070436",
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": "IL",
            "license": "036070436",
            "primary": true
        },
        {
            "code": "261QP2300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Primary Care",
            "state": "IL",
            "license": "336034323",
            "primary": false
        },
        {
            "code": "302R00000X",
            "taxonomy_group": "",
            "desc": "Health Maintenance Organization",
            "state": "IL",
            "license": "336034323",
            "primary": false
        },
        {
            "code": "305R00000X",
            "taxonomy_group": "",
            "desc": "Preferred Provider Organization",
            "state": "IL",
            "license": "336034323",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "036070436",
            "state": "IL"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "jleongmd@cpc.azalea.phimailbox.com",
            "affiliation": "N",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "address_1": "3000 N Cicero Ave",
            "city": "Chicago",
            "state": "IL",
            "country_code": "US",
            "postal_code": "606415106",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "organization_name": "Jack C. Leong MD SC",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Jack C. Leong MD SC",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Kathryn Claire Jablonsky, MED
• Ayman M Jabr, MD
• Cynthia Jacinthe, APN, PMHNP-BC, CNM
• Jack and Jill Therapy Enterprises Inc
• Jack C Leong MD SC
• Jack D. Clemis, MD SC
• Jack M Bulmash MDSC
• Jack S. Litz, D.D.S., LTD.
• Jack Shaw Superior Eye Care
• Jack Zoldan, MD LTD

• Family Medicine Physician in Chicago, IL
• Providers in Chicago, IL by specialty
• Family Medicine Physician in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 20, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.