NPIMap

Individual provider Active NPI

Tommy Kwak, M.D.

  • Internal Medicine Physician
  • Vernon Hills, IL
National Provider Identifier
1235472820
Registry record updated Sep 12, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
036.139684 Issued in IL
Practice address
270 Center Dr Ste 120
Vernon Hills, IL 60061-1564
Phone
(847) 200-1002
Fax
(224) 298-0432
NPI assigned
Apr 1, 2013
Last updated
Sep 12, 2024By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 12, 2024

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X 036.139684 IL Primary
Hospitalist Physician 208M00000X 036139684 IL

Addresses

Primary practice location

270 Center Dr Ste 120
Vernon Hills, IL 60061-1564

Mailing address

270 Center Dr Ste 120
Vernon Hills, IL 60061-1564
Phone (847) 200-1002

Other identifiers 1

IdentifierTypeStateIssuer
036139684OtherILSTATE LICENSE

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
I20160623002184 IL Practitioner - Internal MedicinePractitioner - Hospitalist 6608172291 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Internal Medicine
Education
Other, 2009
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services

Practice addresses (Care Compare)

270 Ctr Dr
Suite 120
Vernon Hills, IL 60061-1564
Phone (847) 200-1002

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
036.139684ILMDInternal Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Stonybrook Center Past Accepting new patients
Stonybrook Center Inc. PastSince Aug 9, 2020 Accepting new patients
Rural Physicians Group-Pannu PLLC Internal Medicine Past Accepting new patients

Interoperability endpoints

  • Direct secure messaging: tkwak49133@sih.direct-ci.com
  • Direct secure messaging: tkwakmd265199@carlehiedirect.net

Organizations & group practices 4

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.

Hospital & facility affiliations 5

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": "1364774400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1726099200000",
    "number": "1235472820",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "270 CENTER DR STE 120",
            "city": "VERNON HILLS",
            "state": "IL",
            "postal_code": "600611564",
            "telephone_number": "847-200-1002",
            "fax_number": "224-298-0432"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "270 CENTER DR STE 120",
            "city": "VERNON HILLS",
            "state": "IL",
            "postal_code": "600611564",
            "telephone_number": "847-200-1002",
            "fax_number": "224-298-0432"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KWAK",
        "first_name": "TOMMY",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2013-04-01",
        "last_updated": "2024-09-12",
        "certification_date": "2024-09-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "IL",
            "license": "036.139684",
            "primary": true
        },
        {
            "code": "208M00000X",
            "taxonomy_group": "",
            "desc": "Hospitalist",
            "state": "IL",
            "license": "036139684",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "STATE LICENSE",
            "identifier": "036139684",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Vernon Hills, IL

Sources for this page

Verify at the official NPI Registry.