JEFFERSON PARK MEDICAL GROUP, P.C.
NPI 1366490047
Family Medicine in Chicago, IL
About Jefferson Park Medical Group, P.c. NPPES
Official registry information on file with the National Plan and Provider Enumeration System.
JEFFERSON PARK MEDICAL GROUP, P.C. (NPI 1366490047) is a healthcare organization registered as a family medicine in Chicago, Illinois and active in the NPI registry since May 2006. The organization holds a CLIA Waiver certificate valid through May 1, 2027 and lists Richard Ansfield, Director, as its authorized official.
NPPES Registry Identity
Specialties & Licenses
Other Identifiers 1
Group Practice 1
Medicare Participation & PECOS CMS
Medicare enrollment and the clinicians who bill Medicare through this organization, from CMS.
Medicare Enrollment Status
Enrolled in Medicare (PECOS)
Jefferson Park Medical Group, P.c. is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).
Clinicians Billing Medicare Through This Organization
8Medicare enrollment records show 8 clinicians reassign Medicare billing to Jefferson Park Medical Group, P.C., which bills Medicare for the services they deliver. Of these, 1 practice at this address. They are listed nearest first.
Clinicians, nearest first (8)
Source: CMS Revalidation Reassignment List, October 2026 release. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.
CLIA Laboratory Certificates CMS CLIA
Laboratory certificates issued under the Clinical Laboratory Improvement Amendments (CLIA) program, which sets federal quality standards for human laboratory testing in the United States. There is no official CMS crosswalk between CLIA and NPI numbers; these certificates are associated with this NPI by matching facility names, locations and phone numbers in the CMS CLIA registry.
Certificate of Waiver 14D1012161
Jefferson Park Medical Group PC · Chicago, ILFrequently Asked Questions NPPES & CMS
Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.
What is Jefferson Park Medical Group, P.C.'s NPI number?
The NPI number for Jefferson Park Medical Group, P.C. is 1366490047. It was assigned to this organization in the NPPES registry on May 4, 2006.
Where is Jefferson Park Medical Group, P.C. located?
Jefferson Park Medical Group, P.C. is located at 5906 N Milwaukee Ave, Chicago, IL 60646. The listed phone number is (773) 774-7300.
What is Jefferson Park Medical Group, P.C.'s specialty?
The primary specialty registered for this NPI is Family Medicine with taxonomy code 207Q00000X.
Is Jefferson Park Medical Group, P.C. enrolled in Medicare?
Yes. Jefferson Park Medical Group, P.C. is registered in the Medicare PECOS enrollment system.
How many clinicians bill Medicare through Jefferson Park Medical Group, P.C.?
According to the CMS Revalidation Reassignment List (October 2026 release), 8 clinicians reassign their Medicare billing to Jefferson Park Medical Group, P.C., in Cardiovascular Disease (Cardiology), Family Practice, General Practice, Internal Medicine, Nurse Practitioner and 2 other specialties. A reassignment is filed with Medicare on form CMS-855R, signed by both the clinician and the organization, and lets the organization bill Medicare and receive payment for the clinician's services. Of these, 1 practice at this address. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.
Does Jefferson Park Medical Group, P.C. hold a CLIA laboratory certificate?
Yes. A Certificate of Waiver (number 14D1012161) is associated with this NPI, valid through May 1, 2027. CLIA certificates authorize laboratory testing under the federal Clinical Laboratory Improvement Amendments program.
When was this NPI record last updated?
The NPPES record for Jefferson Park Medical Group, P.C. was last updated on August 22, 2020. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 6 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.
# Jefferson Park Medical Group, P.c. · NPI 1366490047
Family Medicine organization in Chicago, Illinois. Organization record, active in the CMS NPPES registry since May 4, 2006.
## Identity
- **NPI:** 1366490047 (Entity type: Organization)
- **Enumerated:** May 4, 2006
- **Primary specialty:** Family Medicine · taxonomy 207Q00000X
- **Organization subpart:** No
- **Authorized official:** Richard Ansfield, DIRECTOR
## Practice location
- **Address:** 5906 N MILWAUKEE AVE, Chicago, IL 60646-5420
- **Phone:** (773) 774-7300 · **Fax:** (773) 774-7313
## Medicare
- **Medicare:** Enrolled in Medicare (PECOS)
- **Clinicians billing through this organization:** 8 clinicians in 7 Medicare specialties reassign Medicare billing to this organization (form CMS-855R); largest: Nurse Practitioner (2), Cardiovascular Disease (Cardiology) (1), Family Practice (1); 1 practice at this address · CMS Revalidation Reassignment List, October 2026 release
## Record status
- **NPPES last updated:** August 22, 2020
- **Other identifiers:** Other 01630200 (IL)
- **CLIA laboratory certificates:** 1 on file
---
Source: [NPI Profile](https://npiprofile.com/npi/1366490047) · Data from the CMS NPPES public registry.