PARK PRIMARY CARE LTD
NPI 1891984068
General Practice in Evergreen Park, IL
About Park Primary Care Ltd NPPES
Official registry information on file with the National Plan and Provider Enumeration System.
PARK PRIMARY CARE LTD (NPI 1891984068) is a healthcare organization registered as a general practice in Evergreen Park, Illinois and active in the NPI registry since October 2007. The organization holds a CLIA Waiver certificate valid through November 13, 2027 and lists George Thomas, Owner, 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)
Park Primary Care Ltd is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).
Clinicians Billing Medicare Through This Organization
5Medicare enrollment records show 5 clinicians reassign Medicare billing to Park Primary Care Ltd, which bills Medicare for the services they deliver. Of these, 4 practice at this address. They are listed nearest first.
Clinicians, nearest first (5)
Evergreen Park, IL 60805
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 14D1047764
Park Primary Care, Ltd · Evergreen Park, 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 Park Primary Care Ltd's NPI number?
The NPI number for Park Primary Care Ltd is 1891984068. It was assigned to this organization in the NPPES registry on October 23, 2007.
Where is Park Primary Care Ltd located?
Park Primary Care Ltd is located at 9760 S Kedzie Ave Suite 2, Evergreen Park, IL 60805. The listed phone number is (708) 423-8150.
What is Park Primary Care Ltd's specialty?
The primary specialty registered for this NPI is General Practice with taxonomy code 208D00000X.
Is Park Primary Care Ltd enrolled in Medicare?
Yes. Park Primary Care Ltd is registered in the Medicare PECOS enrollment system.
How many clinicians bill Medicare through Park Primary Care Ltd?
According to the CMS Revalidation Reassignment List (October 2026 release), 5 clinicians in 3 Medicare specialties reassign their Medicare billing to Park Primary Care Ltd. 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. The largest specialties are Family Practice (3), Internal Medicine (1) and Nurse Practitioner (1). Of these, 4 practice at this address. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.
Does Park Primary Care Ltd hold a CLIA laboratory certificate?
Yes. A Certificate of Waiver (number 14D1047764) is associated with this NPI, valid through November 13, 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 Park Primary Care Ltd was last updated on June 17, 2025. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 16 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.
# Park Primary Care Ltd · NPI 1891984068
General Practice organization in Evergreen Park, Illinois. Organization record, active in the CMS NPPES registry since October 23, 2007.
## Identity
- **NPI:** 1891984068 (Entity type: Organization)
- **Enumerated:** October 23, 2007
- **Primary specialty:** General Practice · taxonomy 208D00000X
- **Organization subpart:** No
- **Authorized official:** George Thomas, OWNER
## Practice location
- **Address:** 9760 S KEDZIE AVE, SUITE 2, Evergreen Park, IL 60805-3109
- **Phone:** (708) 423-8150 · **Fax:** (708) 423-8152
## Medicare
- **Medicare:** Enrolled in Medicare (PECOS)
- **Clinicians billing through this organization:** 5 clinicians in 3 Medicare specialties reassign Medicare billing to this organization (form CMS-855R); largest: Family Practice (3), Internal Medicine (1), Nurse Practitioner (1); 4 practice at this address · CMS Revalidation Reassignment List, October 2026 release
## Record status
- **NPPES last updated:** June 17, 2025
- **Other identifiers:** Other CA1215 (IL)
- **CLIA laboratory certificates:** 1 on file
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Source: [NPI Profile](https://npiprofile.com/npi/1891984068) · Data from the CMS NPPES public registry.