NPIMap

Individual provider Active NPI

Jesse K Park, MD

  • Internal Medicine Physician
  • Burr Ridge, IL
National Provider Identifier
1215042072
Registry record updated Apr 14, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
036080235 Issued in IL
Practice address
100 Tower Dr
Suite 105
Burr Ridge, IL 60527
Phone
(630) 325-8681
Fax
(630) 325-3936
NPI assigned
Aug 20, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 14, 2010

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X 036080235 IL Primary

Addresses

Primary practice location

100 Tower Dr
Suite 105
Burr Ridge, IL 60527

Mailing address

100 Tower Dr
Suite 105
Burr Ridge, IL 60527
Phone (630) 325-8681

Other identifiers 1

IdentifierTypeStateIssuer
D36080235MedicaidIL

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IL
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20060123000064 IL Practitioner - Internal Medicine 4284658972 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Internal Medicine
Education
Eastern Virginia Medical School, 1987
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services

Practice addresses (Care Compare)

100 Tower Dr
Suite 105
Burr Ridge, IL 60527-5778
Phone (630) 655-8681

Hospital & facility affiliations

  • Uchicago Medicine Adventhealth Home Care Home health agency, La Grange, IL, CCN 147207
  • Uchicago Medicine Adventhealth Hinsdale Hospital, Hinsdale, IL, CCN 140122
  • Uchicago Medicine Adventhealth Bolingbrook Hospital, Bolingbrook, IL, CCN 140304
  • Uchicago Medicine Adventhealth la Grange Hospital, La Grange, IL, CCN 140065
  • Advocate Good Samaritan Hospital Hospital, Downers Grove, IL, CCN 140288
  • Northwestern Medicine Delnor Community Hospital Hospital, Geneva, IL, CCN 140211

Procedures performed for Medicare patients

ProcedureNumber of procedures
Removal of skin lesions65

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

Practice roles

OrganizationSpecialtyStatusNew patients
Jesse K. Park MD SC CurrentSince Mar 15, 2000 Accepting new patients

Locations

100 Tower Dr
Ste 105
Burr Ridge, IL 60527
Phone (630) 325-8681

Organizations & group practices 1

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

Hospital & facility affiliations 8

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1156032000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1271203200000",
    "number": "1215042072",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "100 TOWER DR",
            "address_2": "SUITE 105",
            "city": "BURR RIDGE",
            "state": "IL",
            "postal_code": "60527",
            "telephone_number": "630-325-8681",
            "fax_number": "630-325-3936"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "100 TOWER DR",
            "address_2": "SUITE 105",
            "city": "BURR RIDGE",
            "state": "IL",
            "postal_code": "60527",
            "telephone_number": "630-325-8681",
            "fax_number": "630-325-3936"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PARK",
        "first_name": "JESSE",
        "middle_name": "K",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-08-20",
        "last_updated": "2010-04-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "IL",
            "license": "036080235",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "D36080235",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Burr Ridge, IL

Sources for this page

Verify at the official NPI Registry.