Active NPI
Richard Dejong
- Family Medicine Physician
- Chicago, IL
National Provider Identifier
1871531103
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Medicine Physician
- License
- 036060489
- Practice address
- 5841 S Maryland Ave
Chicago, IL 60637-1443 - Phone
- (888) 824-0200
- NPI assigned
- Jun 2, 2006
- Last updated
- Oct 24, 2022
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | 036060489 | IL | Primary |
Addresses
Primary practice location
5841 S Maryland Ave
Chicago, IL 60637-1443
Mailing address
150 Harvester Dr
Suite 300
Burr Ridge, IL 60527-5919
Electronic endpoints 1
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| Direct Messaging Address | rdejongmd134355@uchospital.direct-ci.com | University of Chicago Physicians Group |
Medicare participation
Medicare enrollment files- 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
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20100603000714 | IL | Practitioner - Family Practice | 9234103342 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Primary Health Associates PC | Family Medicine | Past | Accepting new patients |
Interoperability endpoints
- https://fhir4.healow.com/fhir/r4/JGEBDA
- rdejongmd134355@uchospital.direct-ci.com
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1149206400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1666569600000",
"number": "1871531103",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "150 HARVESTER DR",
"address_2": "SUITE 300",
"city": "BURR RIDGE",
"state": "IL",
"postal_code": "605275919"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "5841 S MARYLAND AVE",
"city": "CHICAGO",
"state": "IL",
"postal_code": "606371443",
"telephone_number": "888-824-0200"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DEJONG",
"first_name": "RICHARD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-06-02",
"last_updated": "2022-10-24",
"status": "A"
},
"taxonomies": [
{
"code": "207Q00000X",
"taxonomy_group": "",
"desc": "Family Medicine",
"state": "IL",
"license": "036060489",
"primary": true
}
],
"identifiers": [],
"endpoints": [
{
"endpointType": "DIRECT",
"endpointTypeDescription": "Direct Messaging Address",
"endpoint": "rdejongmd134355@uchospital.direct-ci.com",
"affiliation": "Y",
"affiliationName": "University of Chicago Physicians Group",
"address_1": "5841 S Maryland Ave",
"city": "Chicago",
"state": "IL",
"country_code": "US",
"postal_code": "606371443",
"country_name": "United States",
"address_type": "DOM"
}
],
"other_names": []
}
Other providers in Chicago, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 24, 2022; 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.