Individual provider Active NPI

David H Park, MD

  • Surgery Physician
  • La Grange Highlands, IL
National Provider Identifier
1326057969
Registry record updated Mar 25, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Surgery PhysicianTaxonomy code 208600000X
License
036-114009 Issued in IL
Practice address
5201 Willow Springs Rd
Suite #290
La Grange Highlands, IL 60525-6537
Phone
(708) 579-0018
Fax
(708) 579-7571
NPI assigned
Aug 5, 2006
Last updated
Mar 25, 2021By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 25, 2021

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Surgery Physician 208600000X 036-114009 IL Primary

Addresses

Primary practice location

5201 Willow Springs Rd
Suite #290
La Grange Highlands, IL 60525-6537

Mailing address

5201 Willow Springs Rd
Suite #290
La Grange Highlands, IL 60525-6537
Phone (708) 579-0018

Other identifiers 2

IdentifierTypeStateIssuer
399690OtherGROUP PTAN
403270OtherGROUP PTAN

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address david.park.1@380.direct.athenahealth.com

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20051129000948 IL Practitioner - General Surgery 2264452788 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
General Surgery
Education
Other, 1996
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Adventist Health Partners, Inc.Group PAC ID 0244135762, 253 clinicians

Practice addresses (Care Compare)

120 N Oak St
Hinsdale, IL 60521-3829
Phone (630) 856-9000

396 Remington Blvd
Bolingbrook, IL 60440-4311

5101 Willow Springs Rd
La Grange, IL 60525-2600
Phone (708) 245-7044

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Colonoscopy1-10
Hernia repair - groin (open)1-10
Hernia repair (minimally invasive)43
Upper gastrointestinal (GI) endoscopy for acid reflux1-10
Melanoma (skin cancer) excision1-10
Removal of tissue41

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
036-114009ILMDSurgery Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Adventist Health Partners,Inc CurrentSince Nov 1, 2013 Accepting new patients
Adventist Health Partners,Inc CurrentSince Nov 1, 2013 Accepting new patients
Adventist Health Partners, Inc. Current Accepting new patients
Surgical Practice, LTD Surgery Past Accepting new patients
University of Chicago Past Accepting new patients
Adventist Health Partners, Inc Past Accepting new patients

Locations

396 Remington Blvd
Ste 231
Bolingbrook, IL 60440
Phone (630) 312-4301

333 W Chestnut St
Ste 105
Hinsdale, IL 60521
Phone (630) 789-0250

911 N Elm St
Ste 123
Hinsdale, IL 60521
Phone (630) 325-5709

5201 Willow Springs Rd
Ste 290
La Grange Highlands, IL 60525

5101 Willow Springs Rd
Lagrange Hlds, IL 60525
Phone (708) 245-4073

Interoperability endpoints

  • Direct secure messaging: dpark1239586@adventhealth.direct-ci.com

Organizations & group practices 6

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": "1154736000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1616630400000",
    "number": "1326057969",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5201 WILLOW SPRINGS RD",
            "address_2": "SUITE #290",
            "city": "LA GRANGE HIGHLANDS",
            "state": "IL",
            "postal_code": "605256537",
            "telephone_number": "708-579-0018",
            "fax_number": "708-579-7571"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5201 WILLOW SPRINGS RD",
            "address_2": "SUITE #290",
            "city": "LA GRANGE HIGHLANDS",
            "state": "IL",
            "postal_code": "605256537",
            "telephone_number": "708-579-0018",
            "fax_number": "708-579-7571"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PARK",
        "first_name": "DAVID",
        "middle_name": "H",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-08-05",
        "last_updated": "2021-03-25",
        "certification_date": "2021-03-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208600000X",
            "taxonomy_group": "",
            "desc": "Surgery",
            "state": "IL",
            "license": "036-114009",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "GROUP PTAN",
            "identifier": "399690",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "GROUP PTAN",
            "identifier": "403270",
            "state": null
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "david.park.1@380.direct.athenahealth.com",
            "affiliation": "N",
            "address_1": "5201 Willow Springs Rd",
            "address_2": "suite #290",
            "city": "LA Grange Highlands",
            "state": "IL",
            "country_code": "US",
            "postal_code": "605256537",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in La Grange Highlands, IL

Sources for this page

Verify at the official NPI Registry.