Jisun Rebecca Chung

Primary specialty

Mental Health CounselorTaxonomy code 101YM0800X

Practice address

671 S Lewis Ave
Waukegan, IL 60085-6101

Phone

(847) 782-4048

Fax

(847) 782-1030

NPI assigned

Jan 19, 2021

Sex

Female

Sole proprietor

Yes

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: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Mental Health Counselor

Education

Other, 2022

Medicare assignment

May accept Medicare assignment

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

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.

• Chicago Mental Health Institute LLC

  • Mental Health Counselor
  • Northbrook, IL
  • NPI 1063070746
  Medicare reassignment NPD

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

{
    "created_epoch": "1611014400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1611014400000",
    "number": "1871183376",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "671 S LEWIS AVE",
            "city": "WAUKEGAN",
            "state": "IL",
            "postal_code": "600856101",
            "telephone_number": "847-782-4048",
            "fax_number": "847-782-1030"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "671 S LEWIS AVE",
            "city": "WAUKEGAN",
            "state": "IL",
            "postal_code": "600856101",
            "telephone_number": "847-782-4048",
            "fax_number": "847-782-1030"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CHUNG",
        "first_name": "JISUN",
        "middle_name": "REBECCA",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2021-01-19",
        "last_updated": "2021-01-19",
        "certification_date": "2021-01-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Chiro One Wellness Center of Waukegan LLC
• Henry Kwang-Suk Cho, D.M.D
• Harry Chong, L AC.
• Evelyn H Chou, NP
• Jack Robert Chulengarian, DPM
• Kelli A Ciolek
• Circle of Care
• Elisa Cisneros
• City of Waukegan Illinois
• Jerome Clark

• Mental Health Counselor in Waukegan, IL
• Providers in Waukegan, IL by specialty
• Mental Health Counselor in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 19, 2021; 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.