DR. KELLY PARK (M.D.) – MOHS-Micrographic Surgery Physician, NPI 1659683993
MOHS-Micrographic Surgery Physician
Main info
Doctor Profile
Profile Insights
NPPES metrics only — not quality of care.
703 DERMATOLOGY in IL
Provider Addresses for DR. KELLY PARK (M.D.)
2500 S Highland Ave Ste 320
Lombard, IL 601485390
Phone: (815) 744-8554
Type: Location
1124 Essington Rd
Joliet, IL 604358423
Phone: (815) 744-8554
Type: Location
1240 N MILWAUKEE AVE
LIBERTYVILLE, IL 600481307
Phone: (847) 367-5575
Type: Location
755 S Milwaukee Ave Ste 224
Libertyville, IL 600483266
Phone: (847) 250-0138
Type: Location
5000 S 5th Ave
Hines, IL 601413030
Phone: (708) 202-3800
Type: Location
1240 N Milwaukee Ave
Libertyville, IL 600481307
Phone: (847) 367-5575
Type: Location
1800 AMBERLEY CT APT 112
LAKE FOREST, IL 600451057
Phone: (330) 247-8419
Fax: (877) 991-4957
Type: Mailing
1200 SHERMER RD STE 200
NORTHBROOK, IL 600624563
Phone: (847) 559-0090
Type: Location
NPPES updates history
No NPPES updates recorded for this provider.
Prescription Activity
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Open Payments (CMS)
CMS reports 48 Open Payments records for all available years, with a total value of $1,141.
Total Amount is formed as General ($1,141) + Research ($0) + Ownership ($0) = $1,141.
Last reported payment date: 2024-11-20 • Largest payer in this snapshot: ABBVIE INC. ($223).
Total Amount
$1,141
General + Research + Ownership
Payments
48
Total payment records
General Amount
$1,141
General payments
Research Amount
$0
Research funding
Ownership Amount
$0
Ownership interests
Ownership Count
0
Ownership records
Last Payment Date
2024-11-20
Latest reported date
Top Companies
Largest payers in this snapshot
Medicare Enrollment & Revalidation
Source: CMS public data · Not endorsed by CMS ·
Educational use only—not medical, billing, or legal advice.
PECOS enrollment status
Participating (accepts Medicare assignment)
Enrollment effective: 2017-06-27
PECOS data refreshed: 2026-05-27
Medicare revalidation (CMS due date list)
Due date not assigned yet
CMS is tracking this Medicare enrollment for revalidation, but has not published a due date.
Enrollment records
1
Earliest due date
Not assigned (TBD)
CMS data updated
2026-06-01
Revalidation progress
- Medicare enrolled
- On CMS revalidation list
- Due date assigned
- Revalidate in PECOS
CMS enrollment records
| Enrollment ID | Type | Specialty | State | Due date |
|---|---|---|---|---|
| I20170627001862 | I | Dermatology | IL | TBD |
What to do next
- No action required while the due date shows TBD.
- Check the CMS Revalidation Lookup Tool periodically — CMS updates the list about every 60 days.
- Do not submit a revalidation application in PECOS until CMS publishes a concrete due date.
Prepare CMS-855 application → · Look up this NPI in PECOS → · Verify on CMS PECOS
Medicare Utilization (FFS)
Source: CMS public data · Not endorsed by CMS · Beneficiary counts under 11 are suppressed in source data ·
Educational use only—not medical, billing, or legal advice.
Top Medicare procedures (2023) · refreshed 2026-05-27
| HCPCS | Description | Services | Beneficiaries | Medicare allowed |
|---|---|---|---|---|
| 17311 | Removal and microscopic exam of growth of head, neck, hands, feet, or genitals, 1-5 tissue blocks | 129 | 115 | $0 |
| 17312 | Removal and microscopic exam of growth of head, neck, hands, feet, or genitals, each additional stage, 1-5 tissue blocks | 81 | 55 | $0 |
| 12032 | Intermediate repair of wound of scalp, underarms, trunk, arms, or legs, 2.6-7.5 cm | 69 | 65 | $0 |
| 13132 | Complicated repair of wound of forehead, cheeks, chin, mouth, neck, underarms, genitals, hands, or feet, 2.6-7.5 cm | 53 | 50 | $0 |
| 99213 | Established patient office or other outpatient visit, 20-29 minutes | 48 | 37 | $0 |
Insurance plans in this area (ZIP 60148)
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Group practice members
| Name | Specialty | State |
|---|---|---|
| Physician Assistant | WA | |
| D E R M A T O L O G Y | IL | |
| Physician Assistant | IL | |
| Nurse Practitioner | PA | |
| - | IL | |
| - | IL | |
| Nurse Practitioner | IN | |
| Physician Assistant | IL | |
| Physician Assistant | IL | |
| - | IL |
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