Grace Lee Park, M.D.

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

036119920 Issued in IL

Practice address

1109 S. Lincoln Ave.
McKinley Health Center
Urbana, IL 61801

Phone

(217) 333-2711

NPI assigned

Mar 6, 2008

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

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

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

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.

• Promise Healthcare NFP

  • Federally Qualified Health Center (FQHC)
  • Champaign, IL
  • NPI 1578821005
  Medicare reassignment NPD
• Promise Healthcare NFP

  • Federally Qualified Health Center (FQHC)
  • Champaign, IL
  • NPI 1043936438
  NPD
• Promise Healthcare NFP

  • Federally Qualified Health Center (FQHC)
  • Champaign, IL
  • NPI 1801687728
  NPD
• Gibson Community Hospital Association

  • Critical Access Hospital
  • Gibson City, IL
  • NPI 1114935681
  NPD (past)

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

{
    "created_epoch": "1204761600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1507593600000",
    "number": "1619147592",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1109 S. LINCOLN AVE.",
            "address_2": "MCKINLEY HEALTH CENTER",
            "city": "URBANA",
            "state": "IL",
            "postal_code": "61801",
            "telephone_number": "217-333-2711"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1109 S. LINCOLN AVE.",
            "address_2": "MCKINLEY HEALTH CENTER",
            "city": "URBANA",
            "state": "IL",
            "postal_code": "61801",
            "telephone_number": "217-333-2711"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PARK",
        "first_name": "GRACE",
        "middle_name": "LEE",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2008-03-06",
        "last_updated": "2017-10-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "IL",
            "license": "036119920",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Shelly Palmer, MS, RDN, LDN
• Sara Rebeca Palmieri Fermin, MD
• Peggy Palsgaard
• Yagya Pandey
• Dongho Park, N.P.
• James Y Park, DO
• Karina Parke, NP
• Chad Eric Parmenter, BSN RN
• Jared I Parr, PHARMD
• Beth L Parrott, AUD

• Family Medicine Physician in Urbana, IL
• Providers in Urbana, IL by specialty
• Family Medicine Physician in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 10, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.