NPIMap

Organization Active NPI

Jack C. Leong MD SC

  • Family Medicine Physician
  • Chicago, IL
National Provider Identifier
1013448448
Registry record updated Oct 20, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
036070436 Issued in IL
Legal business name
JACK C. LEONG MD SC
Doing business as
Jack C. Leong MD SC
Practice address
3000 N Cicero Ave
Chicago, IL 60641-5106
Phone
(773) 231-2885
NPI assigned
Mar 27, 2017
Last updated
Oct 20, 2020By the provider in NPPES
Organization subpart
Yes
Parent organization
CICERO PROMPT CARE AND FAMILY MEDICAL CENTERAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Oct 20, 2020

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

Authorized official

Name
Dr. Jack C LeongNPI 1174506513
Title
M.D, S.C.
Phone
(773) 282-3115

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 5

Specialty (taxonomy)CodeLicenseStatePrimary
Allergy & Immunology PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207K00000X 036070436 IL
Family Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207Q00000X 036070436 IL Primary
Primary Care Clinic/Center 261QP2300X 336034323 IL
Health Maintenance Organization 302R00000X 336034323 IL
Preferred Provider Organization 305R00000X 336034323 IL

Addresses

Primary practice location

3000 N Cicero Ave
Chicago, IL 60641-5106

Mailing address

3000 N Cicero Ave
Chicago, IL 60641-5106
Phone (773) 231-2885

Other names 1

  • Jack C. Leong MD SC Doing business as

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address jleongmd@cpc.azalea.phimailbox.com Health Information Exchange (HIE)

National Provider Directory

National Provider Directory
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.

Interoperability endpoints

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

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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": [],
    "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"
        }
    ]
}

Other providers in Chicago, IL

Sources for this page

  • 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.