Edward J Park, M.D

Primary specialty

Physical Medicine & Rehabilitation PhysicianTaxonomy code 208100000X

License

036-108857 Issued in IL

Practice address

1401 S California Ave
Chicago, IL 60608-1858

Phone

(773) 522-5120

NPI assigned

Aug 16, 2005

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Other identifiers 1

Electronic endpoints 1

Medicare fee-for-service enrollment

Enrolled in CA

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

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

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.

• Permanente Medical Group Inc

  • Internal Medicine Physician
  • Santa Clara, CA
  • NPI 1073606299

  Physical Medicine & Rehabilitation

  Medicare reassignment NPD
• Permanente Medical Group Inc

  • Internal Medicine Physician
  • Stockton, CA
  • NPI 1548343510

  Physical Medicine & Rehabilitation

  NPD
• Permanente Medical Group, Inc

  • Clinical Medical Laboratory
  • San Jose, CA
  • NPI 1497971584
  NPD
• Mount Sinai Community Foundation

  • General Acute Care Hospital
  • Chicago, IL
  • NPI 1982657854
  NPD (past)
• Schwab Rehabilitation Hospital and Care Network

  • Rehabilitation Hospital
  • Chicago, IL
  • NPI 1700968492
  NPD (past)

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

{
    "created_epoch": "1124150400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1640044800000",
    "number": "1891787008",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1107 S MANNHEIM RD",
            "city": "WESTCHESTER",
            "state": "IL",
            "postal_code": "601542561",
            "telephone_number": "708-786-2900"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1401 S CALIFORNIA AVE",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606081858",
            "telephone_number": "773-522-5120"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PARK",
        "first_name": "EDWARD",
        "middle_name": "J",
        "name_prefix": "Dr.",
        "credential": "M.D",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-08-16",
        "last_updated": "2021-12-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2081P2900X",
            "taxonomy_group": "",
            "desc": "Physical Medicine & Rehabilitation, Pain Medicine",
            "state": "IL",
            "license": "036-108857",
            "primary": false
        },
        {
            "code": "208100000X",
            "taxonomy_group": "",
            "desc": "Physical Medicine & Rehabilitation",
            "state": "IL",
            "license": "036-108857",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "036-108857-2",
            "state": "IL"
        }
    ],
    "endpoints": [
        {
            "endpointType": "SOAP",
            "endpointTypeDescription": "SOAP URL",
            "endpoint": "https://careepicwest.kp.org:14430/Interconnect-prodcalgateway/wcf/epic.community.hie/xcpdrespondinggatewaysync.svc/ncalceq",
            "affiliation": "Y",
            "endpointDescription": "Carequality",
            "affiliationName": "The Permanente Medical Group",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "C-CDA",
            "address_1": "275 W MacArthur Blvd",
            "city": "Oakland",
            "state": "CA",
            "country_code": "US",
            "postal_code": "946115641",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Chul Park
• Claudia Jisung Park, DDS
• Daniel Kwangwon Park, MD
• Danny S Park, MD
• Deric Minwoo Park, MD
• Esther Park
• Eun Jo Park
• Eunsong Park, MD
• Gloria S. Park, RN
• Gye Young Park, M.D.

• Physical Medicine & Rehabilitation Physician in Chicago, IL
• Providers in Chicago, IL by specialty
• Physical Medicine & Rehabilitation Physician in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 21, 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.