Mark Jungjun Cha, NP
Individual provider Active NPI Family Nurse Practitioner · Burbank, IL
NPI 1649864828 · NPPES record last updated Mar 7, 2023
Key facts
- NPI
- 1649864828
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Family Nurse Practitioner 363LF0000X
- License
- 209.021866 (IL)
- Practice address
- 7786 S Cicero Ave
Burbank, IL 60459-1583 - Phone
- (708) 425-3085
- Fax
- (708) 425-3089
- NPI assigned
- Feb 27, 2021
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 12
Medicare Care Compare profile
- Specialty
- Nurse Practitioner
- Education
- Other, 2019
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- Midwest Express Care 2, Inc
Practice addresses (Care Compare)
40 75TH St
Willowbrook, IL 60527-2325
Phone (630) 581-5372
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in IL
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: No
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20211004000086 | IL | Practitioner - Nurse Practitioner | 6901204163 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Nurse Practitioner
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 209.021866 | IL | MD | Nurse Practitioner |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Midwest Express Care 2, Inc | Current |
Accepting new patients | |
| Midwest Express Care 2, Inc | Current |
Accepting new patients |
Locations
12200 Western Ave
Blue Island, IL 60406
Phone (630) 581-5372
7786 S Cicero Ave
Burbank, IL 60459
Phone (708) 425-3085
40 75th St
Willowbrook, IL 60527
Phone (630) 326-5312
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Nurse Practitioner | 363L00000X | 209.021866 | IL | |
| Family Nurse Practitioner | 363LF0000X | 209.021866 | IL | Yes |
Addresses
Primary practice location
7786 S Cicero Ave
Burbank, IL 60459-1583
Mailing address
1616 S School St
Lombard, IL 60148-5041
Phone (773) 517-6498
Other providers in Burbank, IL
- Isabel A Calderon
- Hugo Camacho
- Cardiac Diagnosis, LTD.
- Lawrence E. Casey
- Central Amazing Dental LLC
- Sandeep Chandra
- Suvrat Chandra
- Veronica Alicia Chavez-Gonzalez
- Anita Chavez
- Banesa Chavez
All providers in Burbank, IL · Family Nurse Practitioner in Illinois
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Mar 7, 2023. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.