DR. KELLY PARK M.D.
NPI 1659683993
Dermatology - MOHS-Micrographic Surgery in Northbrook, IL

Q: What is Kelly Park's NPI number?

The NPI number for Kelly Park is 1659683993. It was assigned to this individual provider in the NPPES registry on July 1, 2010. The provider is also known as Dr. Kelly Park M.D..

Q: What is Kelly Park's specialty?

The primary specialty registered for this NPI is Dermatology, specializing in MOHS-Micrographic Surgery, with taxonomy code 207ND0101X.

Q: When was this NPI record last updated?

The NPPES record for Kelly Park was last updated on October 29, 2025. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 12 months 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.

Active since July 01, 2010PECOS EnrolledAccepts Medicare Assignment

1200 SHERMER RD STE 200, NORTHBROOK, IL 60062(847) 559-0090 Get Directions Write a Review

NPPES record last updated: October 29, 2025. Verified against the NPPES registry weekly; last sync: November 08, 2026.

Record update history: Jan 6, 2020, Dec 25, 2018, Mar 19, 2018 and 1 more (4 updates tracked since 2017).

On this page

About Dr. Kelly Park M.d. NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

DR. KELLY PARK M.D. (NPI 1659683993) is an individual mohs-micrographic surgery provider in Northbrook, Illinois, licensed in Illinois (036143099) and active in the NPI registry since July 2010. She is enrolled in Medicare PECOS, maintains 5 additional practice locations, and is a graduate of Northeastern Ohio University College Of Medicine (2009).

NPPES Registry Identity

NPI1659683993

Entity TypeIndividualFemale

Primary Taxonomy207ND0101X

Provider Legal NameDR. KELLY PARKCredential: M.D.

Location Address1200 SHERMER RD STE 200Northbrook, IL 60062-4563

Mailing Address1800 Amberley Ct Apt 112Lake Forest, IL 60045-1057 · (330) 247-8419 · Fax (877) 991-4957

Phone(847) 559-0090

Sole ProprietorNo

Medical School CMSNortheastern Ohio University College Of MedicineGraduated 2009

Enumeration DateJuly 1, 2010

Last NPPES UpdateOctober 29, 20254 updates tracked since enumeration

NPPES CertifiedOctober 29, 2025

✔ NPI 1659683993 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 2

★ Primary SpecialtyDermatology · MOHS-Micrographic SurgeryAllopathic & Osteopathic Physicians

Taxonomy Code207ND0101X

License✔ Licensed in IL · 036143099

Definition

The highly-trained surgeons that perform Mohs Micrographic Surgery are specialists both in dermatology and pathology. With their extensive knowledge of the skin and unique pathological skills, they are able to remove only diseased tissue, preserving healthy tissue and minimizing the cosmetic impact of the surgery. Mohs surgeons who belong to the American College of Mohs Surgery (ACMS) have completed a minimum of one year of fellowship training at one of the ACMS-approved training centers in the U.S.

Also ListedDermatologyTaxonomy 207N00000X · License 036.143099 (IL)

1200 SHERMER RD STE 200, Northbrook, IL 60062

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Other Names 1

Professional Name (2)Dr. Kelly Park M.d.

Secondary Practice Locations 5

Location 11240 N Milwaukee AveLibertyville, IL 60048-1307 · Phone (847) 367-5575

Location 2755 S Milwaukee Ave Ste 224Libertyville, IL 60048-3266 · Phone (847) 250-0138

Location 32500 S Highland Ave Ste 320Lombard, IL 60148-5390 · Phone (815) 744-8554

Location 41124 Essington RdJoliet, IL 60435-8423 · Phone (815) 744-8554

Location 55000 S 5th AveHines, IL 60141-3030 · Phone (708) 202-3800

Accepted Insurance

The full list of accepted plans is on the Insurance tab. Issuers include Anthem Blue Cross and Blue Shield.Insurance ›

Medicare Participation & PECOS CMS

Medicare enrollment, assignment, billing reassignment, and ordering and referring status from CMS.

Medicare Enrollment Status

✔

Enrolled in Medicare and accepts Medicare assignment

Dr. Kelly Park M.d. is registered in PECOS and agrees to accept the Medicare-approved amount as full payment. Medicare patients are not billed beyond the standard deductible and coinsurance.

PECOS PAC ID9830499417

PECOS Enrollment IDI20170627001862

Eligible to Order & Refer✔ Part B Labs & Imaging✔ Durable Medical Equipment✔ Home Health Agency✔ Power Mobility DevicesPer the CMS Ordering and Referring file. Eligibility means Medicare pays claims that this provider orders or refers for these categories.

Medicare Billing Reassignment

Medicare enrollment records show Kelly Park reassigns Medicare billing to 1 organization. The organization bills Medicare for the services this provider delivers there.

Illinois Dermatology Institute, LLC

6.6 mi

Dermatology

9711 SKOKIE BLVD, SUITE J.
Skokie, IL 60077

Reassigned Medicare billing, Illinois enrollment
33 clinicians in this Medicare group

NPI 1891920898 (847) 675-9711

Source: CMS Revalidation Reassignment List, October 2026 release. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.

Areas of Expertise CMS Part B claims 23

Services this provider delivered to Medicare fee-for-service patients, from the CMS Medicare utilization data. Higher counts generally reflect more experience with a service; care delivered outside Medicare is not included.

Established patient office or other outpatient visit with low level od decision making, if using time, 20 minutes or more 99213

This is a routine visit for patients who have already been seen by the healthcare provider. During this approximately 20-29 minute appointment, your health status will be evaluated and any necessary treatments or tests will be discussed. It's a chance to address any health concerns you may have.

225 services165 patients

Destruction of precancer skin growth, 2-14 growths 17003

This procedure involves removing 2-14 precancerous skin growths. The growths are treated to prevent them from potentially developing into skin cancer. The process is safe, with minimal discomfort, and promotes healthier skin.

193 services38 patients

Removal and microscopic exam of growth of head, neck, hands, feet, or genitals, 1-5 tissue blocks 17311

This procedure involves the careful removal of a growth from the head, neck, hands, or feet. The removed tissue, divided into 1-5 blocks, is then examined under a microscope to study its characteristics and determine the nature of the growth.

172 services145 patients

Established patient office or other outpatient visit with moderate level of decision making, if using time, 30 minutes or more 99214

This is a routine check-up for patients who have previously visited our clinic. It involves a comprehensive review of your health and any ongoing treatments. The consultation lasts between 30-39 minutes, allowing enough time to discuss any concerns.

89 services71 patients

Destruction of precancer skin growth, 1 growth 17000

"Destruction of precancer skin growth" is a procedure that eliminates a single precancerous skin growth. This is done to prevent it from developing into skin cancer. The growth may be removed using various methods such as cryotherapy (freezing), laser therapy, or topical medications.

84 services68 patients

Established patient office or other outpatient visit with straightforward medical decision making, if using time, 10 minutes or more 99212

This is a routine check-up for patients who have previously seen the doctor. During this 10-19 minute visit, the doctor will review your health status, discuss any concerns, and manage ongoing treatments or medications. It's a chance to ensure your health is on track.

81 services68 patients

Ultrasonic guidance for placement of radiation therapy fields G6001

Ultrasonic guidance for radiation therapy fields involves using sound waves to create images of the treatment area. This helps to precisely locate the area needing radiation therapy, ensuring the treatment is directed accurately, minimizing harm to healthy tissues.

68 services14 patients

Removal and microscopic exam of growth of head, neck, hands, feet, or genitals, each additional stage, 1-5 tissue blocks 17312

This procedure involves the careful removal of abnormal growths from the head, neck, hands, or feet. The removed tissues, divided into 1-5 blocks, are then examined under a microscope to identify any irregularities. The process may be carried out in multiple stages for thorough examination.

67 services54 patients

Obtaining data needed to develop the optimal radiation treatment, 1 treatment area 77280

This procedure involves gathering essential information to create the best radiation treatment plan for a specific area. It includes scanning the treatment area and using this data to calculate the precise dose of radiation needed to target the disease effectively, while sparing healthy tissue.

67 services14 patients

Biopsy of related skin growth, first growth 11102

A biopsy of a skin growth involves taking a small sample of the growth to examine it under a microscope. This helps determine if the growth is harmful. The procedure is typically quick, with minimal discomfort. It's a crucial step in ensuring your skin's health.

66 services62 patients

Superficial and/or low voltage radiation treatment delivery 77401

Superficial and/or low voltage radiation treatment delivery is a non-invasive procedure used to treat certain diseases like skin cancer. It uses low energy radiation to target and destroy abnormal cells, aiding in halting disease progression.

66 services14 patients

Destruction of skin growth, 1-14 growths 17110

"Destruction of skin growth" refers to a procedure where 1-14 abnormal skin growths are removed. This is done using methods such as freezing, burning, or laser therapy. It helps prevent the growth from causing discomfort or turning into a more serious condition.

64 services49 patients

Intermediate repair of wound of scalp, underarms, trunk, arms, or legs, 2.6-7.5 cm 12032

This procedure involves the repair of a wound between 2.6-7.5 cm located on the scalp, underarms, trunk, arms, or legs. The process includes cleaning, debridement (removal of damaged tissue), and suturing (stitching) of the wound to promote healing.

60 services56 patients

Removal and microscopic exam of growth of trunk, arms, or legs, 1-5 tissue blocks 17313

This procedure involves the removal of a growth from your trunk, arms, or legs. The removed tissue, divided into 1-5 blocks, is then examined under a microscope to identify any abnormalities. This helps in diagnosing and planning further treatment.

57 services47 patients

Complicated repair of wound of forehead, cheeks, chin, mouth, neck, underarms, genitals, hands, or feet, 2.6-7.5 cm 13132

This procedure involves the complex repair of a wound in areas like the forehead, cheeks, chin, mouth, neck, underarms, hands, or feet. The wound size ranges from 2.6-7.5 cm. The process includes cleaning, removing damaged tissue, and stitching the wound for proper healing.

44 services42 patients

Complicated repair of wound of scalp, arms, or legs, 2.6-7.5 cm 13121

This is a procedure to repair a complex wound on your scalp, arm, or leg that is 2.6-7.5 cm long. It involves cleaning, removing damaged tissue, and stitching the wound to promote healing. It's performed under local or general anesthesia.

38 services36 patients

New patient office or other outpatient visit with low level of medical decision making, if using time, 30 minutes or more 99203

This service involves an initial office or outpatient visit for a new patient. The healthcare professional will spend 30-44 minutes understanding your health history, current issues, and discussing possible treatment plans. It's a comprehensive evaluation to start your healthcare journey.

37 services37 patients

Removal of cancer skin growth of body, arms, or legs, 2.1-3.0 cm 11603

This procedure involves the removal of a cancerous skin growth, between 2.1 and 3.0 cm, from the body, arms, or legs. The area is numbed, then the growth is carefully cut out. The goal is to eliminate all cancer cells while minimizing scarring.

28 services27 patients

Complicated repair of wound of forehead, cheeks, chin, mouth, neck, underarms, genitals, hands, or feet, 1.1-2.5 cm 13131

This procedure involves the complex repair of a wound in areas like the forehead, cheeks, chin, mouth, neck, underarms, hands, or feet. The wound size is between 1.1-2.5 cm. This repair may involve multiple layers of sutures and could require reconstruction of the skin.

28 services27 patients

Removal and microscopic exam of growth of trunk, arms, or legs, each additional stage, 1-5 tissue blocks 17314

This procedure involves removing growths from the trunk, arms, or legs. The removed tissues, divided into 1-5 blocks, are then examined under a microscope to identify any abnormalities. This aids in diagnosing and treating your condition effectively.

25 services17 patients

Biopsy of related skin growth, each additional growth 11103

A biopsy of related skin growth is a procedure where a small piece of skin growth is removed for testing. If additional growths are identified, they may also be biopsied. This helps in diagnosing skin conditions and planning appropriate treatment.

24 services15 patients

Removal of cancer skin growth of body, arms, or legs, 1.1-2.0 cm 11602

This procedure involves the surgical removal of a cancerous skin growth on the body, arms, or legs. The growth is between 1.1 and 2.0 cm in size. The goal is to eliminate cancer cells and prevent them from spreading to other parts of the body.

17 services17 patients

New patient office or other outpatient visit with moderate level of medical decision making, if using time, 45 minutes or more 99204

This is a first-time office or outpatient visit lasting between 45-59 minutes. The healthcare provider evaluates your health, discusses your medical history, and may suggest further tests or treatments. It's an opportunity to ask questions and understand your health better.

11 services11 patients

Physician Visit Costs CMS claims · ZIP area

Typical Medicare office-visit costs in the 60062 ZIP code area, from fee-for-service claims. These are area statistics, not this provider’s prices; actual charges vary by service and coverage.

New Patient

$94.06 typical visit price

range $60.08 – $183.39

Typical copayment $23.51 (range $15.02 – $45.84)

Most-billed visit code 99203

Established Patient

$74.80 typical visit price

range $18.97 – $148.12

Typical copayment $18.70 (range $4.74 – $37.03)

Most-billed visit code 99213

Amounts reflect what Medicare beneficiaries in this ZIP area are typically charged for office visits. Patients with other coverage should check their individual plans.

Frequently 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 Kelly Park's NPI number?

The NPI number for Kelly Park is 1659683993. It was assigned to this individual provider in the NPPES registry on July 1, 2010. The provider is also known as Dr. Kelly Park M.D..

Where is Kelly Park located?

Kelly Park practices at 1200 Shermer Rd Ste 200, Northbrook, IL 60062. The listed phone number is (847) 559-0090.

What is Kelly Park's specialty?

The primary specialty registered for this NPI is Dermatology, specializing in MOHS-Micrographic Surgery, with taxonomy code 207ND0101X.

Is Kelly Park enrolled in Medicare?

Yes. Kelly Park is registered in the Medicare PECOS system and accepts Medicare assignment, which means accepting the Medicare-approved amount as payment in full for covered services.

Which organization bills Medicare for Kelly Park's services?

According to the CMS Revalidation Reassignment List (October 2026 release), Kelly Park reassigns Medicare benefits to Illinois Dermatology Institute, LLC (Skokie, IL). The 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 Kelly Park's services. Reassignment records can lag staffing changes; confirm current arrangements with the organization.

What insurance does Kelly Park accept?

Health plans from Anthem Blue Cross and Blue Shield list Kelly Park as in-network in at least one marketplace plan. Coverage varies by plan and year; verify with the insurer or the provider before a visit.

When was this NPI record last updated?

The NPPES record for Kelly Park was last updated on October 29, 2025. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 12 months 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.