Jack C Leong MD SC

Primary specialty

Primary Care Clinic/CenterTaxonomy code 261QP2300X

License

036070436 Issued in IL

Legal business name

JACK C LEONG MD SC

Practice address

3000 N Cicero Ave
Chicago, IL 60641-5106

Phone

(773) 282-3115

Fax

(773) 282-0590

NPI assigned

Jul 10, 2007

Organization subpart

No

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

Authorized official

Name

Dr. Jack C Leong, MDNPI 1174506513

Title

Medical Director

Phone

(773) 282-3115

Specialties & licenses 1

Addresses

Electronic endpoints 1

Medicare fee-for-service enrollment

Enrolled in IL

Enrollment records 1

Tax ID family

Jack C Leong MD SC2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

• Jack C. Leong MD SC

  • Family Medicine Physician
  • Chicago, IL
  • NPI 1013448448
  NPD tax ID

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Jack Leong, MD

  • Pediatrics Physician
  • Chicago, IL
  • NPI 1174506513
  Medicare reassignment NPD Authorized official

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

{
    "created_epoch": "1184025600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1603152000000",
    "number": "1437357480",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3000 N CICERO AVE",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606415106",
            "telephone_number": "773-282-3115",
            "fax_number": "773-282-0590"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3000 N CICERO AVE",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606415106",
            "telephone_number": "773-282-3115",
            "fax_number": "773-282-0590"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "JACK C LEONG MD SC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-07-10",
        "last_updated": "2020-10-20",
        "certification_date": "2020-10-20",
        "status": "A",
        "authorized_official_last_name": "LEONG",
        "authorized_official_first_name": "JACK",
        "authorized_official_middle_name": "C",
        "authorized_official_title_or_position": "MEDICAL DIRECTOR",
        "authorized_official_telephone_number": "773-282-3115",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "261QP2300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Primary Care",
            "state": "IL",
            "license": "036070436",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "jleongmd@cpc.azalea.phimailbox.com",
            "affiliation": "N",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "address_1": "3000 N Cicero Ave",
            "city": "Chicago",
            "state": "IL",
            "country_code": "US",
            "postal_code": "606415106",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Renea Jablonski
• Kathryn Claire Jablonsky, MED
• Ayman M Jabr, MD
• Cynthia Jacinthe, APN, PMHNP-BC, CNM
• Jack and Jill Therapy Enterprises Inc
• Jack C. Leong MD SC
• Jack D. Clemis, MD SC
• Jack M Bulmash MDSC
• Jack S. Litz, D.D.S., LTD.
• Jack Shaw Superior Eye Care (superior eye care)

• Primary Care Clinic/Center in Chicago, IL
• Providers in Chicago, IL by specialty
• Primary Care Clinic/Center in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 20, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.