Kenneth Park, PA-C

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

085003022 Issued in IL

Practice address

3860 W Ogden Ave
Chicago, IL 60623-2460

Phone

(872) 588-3000

NPI assigned

Sep 8, 2008

Last updated

Aug 31, 2022By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in IL, MO2 enrollments

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 2

Specialty

Physician Assistant

Education

Other, 2007

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

Practice roles

Locations

Interoperability endpoints

• FHIR API: https://fhir4.healow.com/fhir/r4/DHDHAA
• Direct secure messaging: kpark690990@direct.ochin.org

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Lawndale Christian Health Center

  • Federally Qualified Health Center (FQHC)
  • Chicago, IL
  • NPI 1245289214
  Medicare reassignment NPD
• Advocates for a Healthy Community, Inc

  dba Jordan Valley Community Health Center

  • Federally Qualified Health Center (FQHC)
  • Springfield, MO
  • NPI 1558303057
  Medicare reassignment
• Lawndale Christian Health Center

  • Health Educator
  • Chicago, IL
  • NPI 1588537641
  NPD
• Lawndale Christian Health Center

  dba Lawndale Christian Health Center Pharmacy

  • Community/Retail Pharmacy
  • Chicago, IL
  • NPI 1679680235
  NPD
• Progressive Surgical Associates SC

  • Surgery Physician
  • New Lenox, IL
  • NPI 1154550226
  NPD (past)

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

{
    "created_epoch": "1220832000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1661904000000",
    "number": "1194973768",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3860 W OGDEN AVE",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606232460",
            "telephone_number": "872-588-3000"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3860 W OGDEN AVE",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606232460",
            "telephone_number": "872-588-3000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PARK",
        "first_name": "KENNETH",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2008-09-08",
        "last_updated": "2022-08-31",
        "certification_date": "2022-08-31",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "IL",
            "license": "085003022",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• John Jinso Park
• Jonathan Park
• Julie Eunnah Park, M.D.
• Julienne Park, LAC
• Junyun Park
• Linda Park
• Lisa Marie Park, MOTR/L
• Margaret Park, MD
• Michael Park, MD
• Min Seon Park

• Physician Assistant in Chicago, IL
• Providers in Chicago, IL by specialty
• Physician Assistant in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 31, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.