Active NPI
Jacob Larsen White, DO
- Surgery Physician
- Park Ridge, IL
National Provider Identifier
1023877743
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Surgery Physician
- License
- 125.086986
- Practice address
- 1775 Dempster Street
Mailbox #48
Park Ridge, IL 60068 - Phone
- (847) 723-2210
- Fax
- (847) 723-6987
- NPI assigned
- Mar 15, 2024
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Surgery Physician | 208600000X | 125.086986 | IL | Primary |
Addresses
Primary practice location
1775 Dempster Street
Mailbox #48
Park Ridge, IL 60068
Mailing address
1775 Dempster Street
Mailbox #48
Park Ridge, IL 60068
Phone (847) 723-2210
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Doctor of Osteopathy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 125.086986 | IL | MD | Surgery Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1710460800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1750809600000",
"number": "1023877743",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1775 DEMPSTER STREET",
"address_2": "MAILBOX #48",
"city": "PARK RIDGE",
"state": "IL",
"postal_code": "60068",
"telephone_number": "847-723-2210",
"fax_number": "847-723-3394"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1775 DEMPSTER STREET",
"address_2": "MAILBOX #48",
"city": "PARK RIDGE",
"state": "IL",
"postal_code": "60068",
"telephone_number": "847-723-2210",
"fax_number": "847-723-6987"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WHITE",
"first_name": "JACOB",
"middle_name": "LARSEN",
"credential": "DO",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2024-03-15",
"last_updated": "2025-06-25",
"certification_date": "2025-06-16",
"status": "A"
},
"taxonomies": [
{
"code": "208600000X",
"taxonomy_group": "",
"desc": "Surgery",
"state": "IL",
"license": "125.086986",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Park Ridge, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 25, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.