Jun Soo Park, MD is a medicare enrolled "Student In An Organized Health Care Education/training Program" physician in Maywood, Illinois. His current practice location is
2160 S 1st Ave, Maywood, Illinois. You can reach out to his office (for appointments etc.) via phone at
(847) 345-2121.
Jun Soo Park is licensed to practice in * (Not Available) (license number ) and he also participates in the medicare program. He does not accept medicare assignments directly but he may accept medicare through third-party (refer to Reassignment section below) and may also prescribe medicare part D drugs. His NPI Number is 1659900777.
Physician's Profile
Full Name | Jun Soo Park |
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Gender | Male |
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Speciality | Student In An Organized Health Care Education/training Program |
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Location | 2160 S 1st Ave, Maywood, Illinois |
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Accepts Medicare Assignments | Medicare enrolled and may accept medicare through third-party reassignment. May prescribe medicare part D drugs. |
NPI Data:
- NPI Number: 1659900777
- Provider Enumeration Date: 04/02/2020
- Last Update Date: 02/09/2023
Medicare PECOS Information:
- PECOS PAC ID: 4587037528
- Enrollment ID: I20230222001879
Medical Identifiers
Medical identifiers for Jun Soo Park such as npi, medicare ID, medicare PIN, medicaid, etc.
Identifier | Type | State | Issuer |
1659900777 | NPI | - | NPPES |
Medical Taxonomies and Licenses
Taxonomy | Type | License (State) | Status |
207P00000X | Emergency Medicine | 036162814 (Illinois) | Secondary |
390200000X | Student In An Organized Health Care Education/training Program | (* (Not Available)) | Primary |
Medicare Reassignments
Some practitioners may not bill the customers directly but medicare billing happens through clinics / group practice / hospitals where the provider works. Medicare reassignment of benefits is a mechanism by which practitioners allow third parties to bill and receive payment for medicare services performed by them. Jun Soo Park allows following entities to bill medicare on his behalf.
Entity Name | Chicago Central Emergency Physicians Llp |
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Entity Type | Part B Supplier - Clinic/group Practice |
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Entity Identifiers | NPI Number: 1093162836 PECOS PAC ID: 3072415520 Enrollment ID: O20040123000979 |
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Entity Name | Epss Llc - Lakeside Series |
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Entity Type | Part B Supplier - Clinic/group Practice |
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Entity Identifiers | NPI Number: 1861271181 PECOS PAC ID: 1052769809 Enrollment ID: O20231205000431 |
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Medicare Part D Prescriber Enrollment
Any physician or other eligible professional who prescribes Part D drugs must either enroll in the Medicare program or opt out in order to prescribe drugs to their patients with Part D prescription drug benefit plans. Jun Soo Park is
enrolled with medicare and thus, if eligible, can prescribe medicare part D drugs to patients with medicare part D benefits.
Mailing Address and Practice Location
Mailing Address | Practice Location Address |
Jun Soo Park, MD 2270 S Elizabeth St, Lombard, IL 60148-7124 Ph: (847) 345-2121 | Jun Soo Park, MD 2160 S 1st Ave, Maywood, IL 60153-3328 Ph: (847) 345-2121 |
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