Amanda Park, M.D.

Primary specialty

Anesthesiology PhysicianTaxonomy code 207L00000X

License

036-158292 Issued in IL

Practice address

3134 N Clark St
Chicago, IL 60657-4414

Phone

(773) 766-4949

Fax

(312) 766-4908

NPI assigned

Jun 3, 2016

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Electronic endpoints 2

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

Specialty

Anesthesiology

Education

University of Illinois College of Med (CHI/Peor/Rock/CHM-Urb), 2016

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Advocate Health and Hospitals CorporationGroup PAC ID 7810800935, 3,081 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Advocate Illinois Masonic Medical Center Hospital, Chicago, IL, CCN 140182

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: apark387472@direct.myadvocateaurora.org

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.

• Advocate Health and Hospitals Corporation

  • Multi-Specialty Clinic/Center
  • Oak Brook, IL
  • NPI 1700824455

  IL

  Medicare reassignment NPD
• The Board of Trustees of the University of Illinois

  • Anatomic Pathology Physician
  • Chicago, IL
  • NPI 1386863819

  IL

  Medicare reassignment NPD
• Advocate Health & Hospitals Corp.

  • Emergency Medicine Physician
  • Chicago, IL
  • NPI 1750315545
  NPD
• Advocate Health and Hospitals Corporation

  • Children's Hospital
  • Oak Lawn, IL
  • NPI 1508315516
  NPD
• Board of Trustees of the University of Illinois

  • Critical Care Medicine (Anesthesiology) Physician
  • Chicago, IL
  • NPI 1891913638

  Anesthesiology

  NPD

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

• Advocate North Side Health Network

  • General Acute Care Hospital
  • Chicago, IL
  • NPI 1912014564

  Hospital

  Care Compare affiliation

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

{
    "created_epoch": "1464912000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1703808000000",
    "number": "1780032482",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "29373 NETWORK PL",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606731293",
            "telephone_number": "847-390-5900"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3134 N CLARK ST",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606574414",
            "telephone_number": "773-766-4949",
            "fax_number": "312-766-4908"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "333 Cedar St # Street3",
            "address_2": "YNHH- Dept Anesthesiology",
            "address_purpose": "LOCATION",
            "city": "New Haven",
            "state": "CT",
            "postal_code": "065103206",
            "country_code": "US",
            "telephone_number": "203-785-2802",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "PARK",
        "first_name": "AMANDA",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2016-06-03",
        "last_updated": "2023-12-29",
        "certification_date": "2023-12-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207L00000X",
            "taxonomy_group": "",
            "desc": "Anesthesiology",
            "state": "CT",
            "license": "66631",
            "primary": false
        },
        {
            "code": "207L00000X",
            "taxonomy_group": "",
            "desc": "Anesthesiology",
            "state": "IL",
            "license": "036-158292",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "apark387472@direct.myadvocateaurora.org",
            "affiliation": "N",
            "use": "DIRECT",
            "useDescription": "Direct",
            "address_1": "3134 N Clark St",
            "city": "Chicago",
            "state": "IL",
            "country_code": "US",
            "postal_code": "606574414",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "FHIR",
            "endpointTypeDescription": "FHIR URL",
            "endpoint": "https://EpicFHIR.aurora.org/FHIR/MYAURORA/api/FHIR/DSTU2/",
            "affiliation": "N",
            "address_1": "3134 N Clark St",
            "city": "Chicago",
            "state": "IL",
            "country_code": "US",
            "postal_code": "606574414",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Park View Rehab Center LLC
• Park West Family Dentistry
• Park West Family Dentistry, PC
• Park West Family Physicians S C
• Alex Junwoo Park, MD
• Asher Chulsoon Park
• Candice Kimberly Park, MD
• Carol Yeojin Park, M.D.
• CHI Soo Park
• Chris Park, DDS

• All providers in Chicago, IL
• Anesthesiology Physician in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 29, 2023; 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.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.