Park Avenue Private Practice LLC

Primary specialty

Health Service Clinic/CenterTaxonomy code 261QH0100X

License

248.001237 Issued in IL

Legal business name

PARK AVENUE PRIVATE PRACTICE LLC

Practice address

767 Park Ave W Ste 350
Highland Park, IL 60035-2472

Phone

(847) 433-5505

Fax

(847) 433-5510

NPI assigned

Oct 26, 2015

Organization subpart

No

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

Authorized official

Name

Jeffrey S Garland, M.D.NPI 1477506483

Title

President, Medical Doctor

Phone

(847) 433-5505

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in IL

Enrollment records 1

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Interoperability endpoints

• Direct secure messaging: jeffreygarland@papp.allscriptsdirect.net

Practitioners 2

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

• Jeffrey Scott Garland, M.D.

  • Internal Medicine Physician
  • Highland Park, IL
  • NPI 1477506483
  Medicare reassignment NPD Authorized official
• Sharon Denise Fellingham, PA-C

  • Physician Assistant
  • Highland Park, IL
  • NPI 1811965973
  Medicare reassignment

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

{
    "created_epoch": "1445817600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1454371200000",
    "number": "1851763213",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "767 PARK AVE W STE 350",
            "city": "HIGHLAND PARK",
            "state": "IL",
            "postal_code": "600352472",
            "telephone_number": "847-433-5505"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "767 PARK AVE W STE 350",
            "city": "HIGHLAND PARK",
            "state": "IL",
            "postal_code": "600352472",
            "telephone_number": "847-433-5505",
            "fax_number": "847-433-5510"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PARK AVENUE PRIVATE PRACTICE LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-10-26",
        "last_updated": "2016-02-02",
        "status": "A",
        "authorized_official_last_name": "GARLAND",
        "authorized_official_first_name": "JEFFREY",
        "authorized_official_middle_name": "S",
        "authorized_official_title_or_position": "PRESIDENT, MEDICAL DOCTOR",
        "authorized_official_telephone_number": "847-433-5505",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "261QH0100X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Health Service",
            "state": "IL",
            "license": "248.001237",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Reid M Owen, M.D.
• Carlton Christoher Owens, LMT
• Milton Leslie Paige X, M.D.
• Isabella J. Pak, APN-CNP
• Park Avenue Associates in Internal Medicine, LTD
• Anne M. Parker, APN-CNP
• Gayle M Parsons
• Jenna Pascucci
• Ashish H Patel
• Priya Sheth Patel, PA-C

• Health Service Clinic/Center in Highland Park, IL
• Providers in Highland Park, IL by specialty
• Health Service Clinic/Center in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 2, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• 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.