Justin Kwak, M.D.

Primary specialty

Pediatrics PhysicianTaxonomy code 208000000X

License

036.120211 Issued in IL

Practice address

2400 N Rockton Ave
Rockford Health Physicians
Rockford, IL 61103-3655

Phone

(815) 971-5000

Fax

(815) 968-7830

NPI assigned

Aug 21, 2008

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 2

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.

• Rockford Health Physicians

  • Multi-Specialty Clinic/Center
  • Rockford, IL
  • NPI 1043242886
  Medicare reassignment
• RMH Pathologists, LTD

  • Anatomic Pathology Physician
  • Rockford, IL
  • NPI 1184671992
  NPD
• Empact Emergency Physicians LLC

  • General Acute Care Hospital
  • Aurora, IL
  • NPI 1982985032
  NPD (past)

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

{
    "created_epoch": "1219276800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1409097600000",
    "number": "1700033628",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2400 N ROCKTON AVE",
            "address_2": "ROCKFORD HEALTH PHYSICIANS",
            "city": "ROCKFORD",
            "state": "IL",
            "postal_code": "611033655",
            "telephone_number": "815-971-5000",
            "fax_number": "815-968-7830"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2400 N ROCKTON AVE",
            "address_2": "ROCKFORD HEALTH PHYSICIANS",
            "city": "ROCKFORD",
            "state": "IL",
            "postal_code": "611033655",
            "telephone_number": "815-971-5000",
            "fax_number": "815-968-7830"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KWAK",
        "first_name": "JUSTIN",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2008-08-21",
        "last_updated": "2014-08-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "IL",
            "license": "036.120211",
            "primary": true
        },
        {
            "code": "208M00000X",
            "taxonomy_group": "",
            "desc": "Hospitalist",
            "state": "IL",
            "license": "036120211",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Dennis O Kurz, LCSW
• Devan Grace Kuss, OTR
• Susan R Kutz, APN
• Douglas Thomas Kutzer, LSW
• Ashley Kuznicki, LCSW
• Kathleen L Kwiat-Hess, LCSW
• Raymond Kwong, PA-C
• Donald J Kyle, D.D.S
• Moses Kyobe, MD FACC
• Suzanna Kyulule

• Pediatrics Physician in Rockford, IL
• Providers in Rockford, IL by specialty
• Pediatrics Physician in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 27, 2014; 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.