Individual provider Active NPI

Suzanne Olha Park, CRNA

  • Certified Registered Nurse Anesthetist
  • Melrose Park, IL
National Provider Identifier
1871805648
Registry record updated Oct 15, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Certified Registered Nurse AnesthetistTaxonomy code 367500000X
License
209008274 Issued in IL
Practice address
701 W North Ave
Melrose Park, IL 60160-1612
Phone
(708) 681-7859
NPI assigned
Jul 9, 2010
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 15, 2018

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Registered Nurse 163W00000X 041-336253 IL
Certified Registered Nurse Anesthetist 367500000X 209008274 IL Primary

Addresses

Primary practice location

701 W North Ave
Melrose Park, IL 60160-1612

Mailing address

1121 Lake Cook Rd Ste M
Deerfield, IL 60015-5234
Phone (847) 945-4550

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IL

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20100916001343 IL Practitioner - Certified Registered Nurse Anesthetist (Crna) 6002931813 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Certified Registered Nurse Anesthetist (Crna)
Education
Other, 2010
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Arete Anesthesia LLCGroup PAC ID 6709161961, 11 clinicians
Gottlieb Midwest Anesthesiologists, LLCGroup PAC ID 8123929940, 42 clinicians

Practice addresses (Care Compare)

2750 S River Rd
Des Plaines, IL 60018-4103
Phone (847) 470-8740

5101 Willow Springs Rd
La Grange, IL 60525-2600
Phone (708) 352-1200

701 W N Ave
Melrose Park, IL 60160-1612
Phone (708) 681-3200

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Certified Registered Nurse

State licenses

LicenseStateTypeSpecialty
041-336253ILMDRegistered Nurse
209008274ILMDCertified Registered Nurse Anesthetist

Practice roles

OrganizationSpecialtyStatusNew patients
Gottlieb Midwest Anesthesiologists, LLC CurrentSince Aug 16, 2010 Accepting new patients
Arete Anesthesia LLC CurrentSince Nov 1, 2018 Accepting new patients
Midwest Anesthesia Partners, LLC CurrentSince May 1, 2017 Accepting new patients
Chicago Area Partners in Anesthesia LLC Past Accepting new patients

Locations

2900 N Lakeshore
Chicago, IL 60657
Phone (773) 665-3240

9145 Collection Ctr Dr
Chicago, IL 60693

1121 Lake Cook Rd
Ste M
Deerfield, IL 60015
Phone (847) 945-4550

2750 S River Rd
Des Plaines, IL 60018
Phone (708) 273-3052

701 W North Ave
Melrose Park, IL 60160
Phone (708) 450-5779

9000 Waukegan Rd
#3T
Morton Grove, IL 60053
Phone (847) 213-2700

Organizations & group practices 4

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.

NPI Registry JSON

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

{
    "created_epoch": "1278633600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1539561600000",
    "number": "1871805648",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1121 LAKE COOK RD STE M",
            "city": "DEERFIELD",
            "state": "IL",
            "postal_code": "600155234",
            "telephone_number": "847-945-4550"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "701 W NORTH AVE",
            "city": "MELROSE PARK",
            "state": "IL",
            "postal_code": "601601612",
            "telephone_number": "708-681-7859"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PARK",
        "first_name": "SUZANNE",
        "middle_name": "OLHA",
        "credential": "CRNA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2010-07-09",
        "last_updated": "2018-10-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "163W00000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse",
            "state": "IL",
            "license": "041-336253",
            "primary": false
        },
        {
            "code": "367500000X",
            "taxonomy_group": "",
            "desc": "Nurse Anesthetist, Certified Registered",
            "state": "IL",
            "license": "209008274",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Melrose Park, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 15, 2018; 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.