Individual provider Active NPI

Sangtae Park, MD

  • Urology Physician
  • Skokie, IL
National Provider Identifier
1356300487
Registry record updated Apr 20, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Urology PhysicianTaxonomy code 208800000X
License
036119572 Issued in IL
Practice address
9711 Skokie Blvd
Ste H
Skokie, IL 60077-1384
Phone
(847) 676-2400
Fax
(847) 676-2485
NPI assigned
Mar 18, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 20, 2026

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Urology Physician 208800000X M0855 TX
Urology Physician 208800000X 036119572 IL Primary

Addresses

Primary practice location

9711 Skokie Blvd
Ste H
Skokie, IL 60077-1384

Mailing address

9711 Skokie Blvd
Ste H
Skokie, IL 60077-1384
Phone (847) 676-2400

Other identifiers 1

IdentifierTypeStateIssuer
174078901MedicaidTX

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address spark218691@direct.northshore.org

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
I20071221000141 IL Practitioner - UrologyPractitioner - General Surgery 6800831603 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Urology
Education
Other, 1999
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Endeavor Health Medical GroupGroup PAC ID 2163334699, 3,330 clinicians

Practice addresses (Care Compare)

1000 Central St
Evanston, IL 60201-1779

1300 Oak Ave
Evanston, IL 60201-4205
Phone (847) 869-1300

2100 Pfingsten Rd
Glenview, IL 60026-1301

2180 Pfingsten Rd
Suite 3000
Glenview, IL 60026-1340
Phone (847) 503-3000

2650 Ridge Ave
Evanston, IL 60201-1700

767 Park Ave W
Suite B100
Highland Park, IL 60035-2469
Phone (847) 503-3000

777 Park Ave W
Highland Park, IL 60035-2433

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
84.9 of 100Reported as group
Quality
75.91
Promoting interoperability
99
Improvement activities
40
Cost
74.6

Procedures performed for Medicare patients

ProcedureNumber of procedures
Prostate resection18
Removal of skin lesions1-10

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
036119572ILMDUrology Physician
M0855TXMDUrology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Endeavor Health Medical Group CurrentSince Oct 27, 2010 Accepting new patients
Osf Multi-Specialty Group CurrentSince Dec 1, 2025 Accepting new patients
Central PA Pharmacy LLC. Current Accepting new patients
Endeavor Health Medical Group CurrentSince Oct 27, 2010 Accepting new patients

Locations

9532 Eagle Way
Chicago, IL 60678

49 S Waukegan Rd
Ste 200
Deerfield, IL 60015
Phone (847) 945-4575

2650 Ridge Ave
Evanston, IL 60201
Phone (847) 570-1206

2650 Ridge Ave
#1223
Evanston, IL 60201
Phone (847) 982-3172

1000 Central St
Ste 720
Evanston, IL 60201
Phone (847) 475-8600

2650 Ridge Ave
Ste 2218A
Evanston, IL 60201
Phone (847) 503-4222

2180 Pfingsten Rd
Ste 3000
Glenview, IL 60026
Phone (847) 503-3000

1875 W Dempster St
Ste G04
Park Ridge, IL 60068
Phone (630) 684-9361

8600 State Route 91
Ste 130
Peoria, IL 61615
Phone (309) 683-5050

9711 Skokie Blvd
Ste H
Skokie, IL 60077
Phone (224) 307-4850

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 and National Provider Directory roles.

Hospital & facility affiliations 4

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": "1142640000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1776643200000",
    "number": "1356300487",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9711 SKOKIE BLVD",
            "address_2": "STE H",
            "city": "SKOKIE",
            "state": "IL",
            "postal_code": "600771384",
            "telephone_number": "847-676-2400",
            "fax_number": "847-676-2485"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9711 SKOKIE BLVD",
            "address_2": "STE H",
            "city": "SKOKIE",
            "state": "IL",
            "postal_code": "600771384",
            "telephone_number": "847-676-2400",
            "fax_number": "847-676-2485"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PARK",
        "first_name": "SANGTAE",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-03-18",
        "last_updated": "2026-04-20",
        "certification_date": "2026-04-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208800000X",
            "taxonomy_group": "",
            "desc": "Urology",
            "state": "TX",
            "license": "M0855",
            "primary": false
        },
        {
            "code": "208800000X",
            "taxonomy_group": "",
            "desc": "Urology",
            "state": "IL",
            "license": "036119572",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "174078901",
            "state": "TX"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "spark218691@direct.northshore.org",
            "affiliation": "N",
            "address_1": "9711 Skokie Blvd",
            "address_2": "Ste H",
            "city": "Skokie",
            "state": "IL",
            "country_code": "US",
            "postal_code": "600771384",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Skokie, IL

Sources for this page

Verify at the official NPI Registry.