Jefferson Park Medical Center

Primary specialty

Medical Specialty Clinic/CenterTaxonomy code 261QM2500X

Legal business name

JEFFERSON PARK MEDICAL CENTER

Practice address

4955 N Milwaukee Ave
Chicago, IL 60630-2286

Phone

(630) 209-8405

Fax

(773) 736-1403

NPI assigned

May 22, 2007

Organization subpart

No

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

Authorized official

Name

Pierre Chatelain

Title

Operations Manager

Phone

(630) 209-8405

Specialties & licenses 1

Addresses

Other identifiers 1

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Milroy S Emmanuel, MD

  • Diagnostic Neuroimaging (Radiology) Physician
  • Chicago, IL
  • NPI 1578772570
  NPD (past)

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

{
    "created_epoch": "1179792000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1215648000000",
    "number": "1194934208",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4955 N MILWAUKEE AVE",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606302286",
            "telephone_number": "630-209-8405",
            "fax_number": "773-736-1403"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4955 N MILWAUKEE AVE",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606302286",
            "telephone_number": "630-209-8405",
            "fax_number": "773-736-1403"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "JEFFERSON PARK MEDICAL CENTER",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-05-22",
        "last_updated": "2008-07-10",
        "status": "A",
        "authorized_official_last_name": "CHATELAIN",
        "authorized_official_first_name": "PIERRE",
        "authorized_official_title_or_position": "OPERATIONS MANAGER",
        "authorized_official_telephone_number": "630-209-8405"
    },
    "taxonomies": [
        {
            "code": "261QM2500X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Medical Specialty",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "036046595",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Jeff Rager, DPM
• Jeff Transit LLC
• Jill Starzyk Jeffe, MD
• Jefferson Park Counseling
• Jefferson Park Family Dental LLC
• Jefferson Park Medical Center, LTD.
• Jefferson Park Medical Group, P.C.
• Tanya Jefferson-Fitts
• Serena Jefferson-Jackson
• Deborah Bishop Jefferson, APN-CNP

• Medical Specialty Clinic/Center in Chicago, IL
• Providers in Chicago, IL by specialty
• Medical Specialty Clinic/Center in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 10, 2008; 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.