Individual provider Active NPI

Aeri Paek

  • Family Medicine Physician
  • Oak Park, IL
National Provider Identifier
1366899619
Registry record updated Dec 26, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
036.148877 Issued in IL
Practice address
14 Lake St
Oak Park, IL 60302-2606
Phone
(708) 383-0113
Fax
(708) 383-9911
NPI assigned
May 17, 2016
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 26, 2019

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Student in an Organized Health Care Education/Training Program 390200000X
Family Medicine Physician 207Q00000X 036.148877 IL Primary

Addresses

Primary practice location

14 Lake St
Oak Park, IL 60302-2606

Mailing address

14 Lake St
Oak Park, IL 60302-2606
Phone (708) 383-0113

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
I20190808001481 IL Practitioner - Family Practice 6608160163 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Midwestern University, Chicago College of Osteopathic Med, 2016
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
PCC Community Wellness CenterGroup PAC ID 1557270139, 91 clinicians

Practice addresses (Care Compare)

14 Lake St
Oak Park, IL 60302-2606
Phone 7083830113220005

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
036.148877ILMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
PCC Community Wellness Center CurrentSince Jul 15, 2019 Accepting new patients
PCC Community Wellness Center CurrentSince Jul 15, 2019 Accepting new patients
PCC Community Wellness Center Past Accepting new patients

Locations

6201 Roosevelt Rd
Berwyn, IL 60402
Phone (708) 386-0845

14 Lake St
Oak Park, IL 60302
Phone (708) 383-0113

Interoperability endpoints

  • Direct secure messaging: aeri.paek.1@13158.direct.athenahealth.com

Organizations & group practices 3

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.

NPI Registry JSON

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

{
    "created_epoch": "1463443200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1577318400000",
    "number": "1366899619",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "14 LAKE ST",
            "city": "OAK PARK",
            "state": "IL",
            "postal_code": "603022606",
            "telephone_number": "708-383-0113",
            "fax_number": "708-383-9911"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "14 LAKE ST",
            "city": "OAK PARK",
            "state": "IL",
            "postal_code": "603022606",
            "telephone_number": "708-383-0113",
            "fax_number": "708-383-9911"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PAEK",
        "first_name": "AERI",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2016-05-17",
        "last_updated": "2019-12-26",
        "certification_date": "2019-12-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "IL",
            "license": "036.148877",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Oak Park, IL

Sources for this page

Verify at the official NPI Registry.