Individual provider Active NPI

Magaly Nickles, APN

  • Nurse Practitioner
  • McHenry, IL
National Provider Identifier
1033543129
Registry record updated Sep 3, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nurse PractitionerTaxonomy code 363L00000X
License
209010594 Issued in IL
Practice address
4309 W Medical Center Dr Ste B305
McHenry, IL 60050-8418
Phone
(847) 802-7400
NPI assigned
Aug 26, 2013
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 3, 2020

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Nurse Practitioner 363L00000X 041337837 IL
Nurse Practitioner 363L00000X 209010594 IL Primary

Addresses

Primary practice location

4309 W Medical Center Dr Ste B305
McHenry, IL 60050-8418

Mailing address

4309 W Medical Center Dr Ste B305
McHenry, IL 60050-8418
Phone (847) 802-7400

Other practice location 1

10350 Haligus Rd Ste C
Huntley, IL 60142-9545
Phone (847) 802-7400

Other identifiers 1

IdentifierTypeStateIssuer
209-010594OtherILLICENSE NUMBER

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IL
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20161129002344 IL Practitioner - Nurse Practitioner 8224318779 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2013
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Northwestern Medical Faculty FoundationGroup PAC ID 4587576814, 4,386 clinicians

Practice addresses (Care Compare)

4201 W Medical Ctr Dr
McHenry, IL 60050-8409
Phone (815) 759-4323

4309 W Medical Ctr Dr
Suite A201
McHenry, IL 60050-8411
Phone (815) 759-8070

515 Valley View Dr
Suite 201
Moline, IL 61265-6175
Phone (312) 695-0870

675 N Saint Clair St
Chicago, IL 60611-5975

675 N St Clair
Chicago, IL 60611-5975

Hospital & facility affiliations

  • Northwestern Medicine McHenry Hospital, McHenry, IL, CCN 140116
  • Northwestern Lake Forest Hospital Hospital, Lake Forest, IL, CCN 140130
  • Northwestern Medicine Central Dupage Hospital Hospital, Winfield, IL, CCN 140242

Merit-based Incentive Payment System (MIPS)

Final score
95.19 of 100Reported as apm
Quality
83.05
Promoting interoperability
100
Improvement activities
40

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
041337837ILMDNurse Practitioner
209010594ILMDNurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Northwestern Medical Faculty Foundation CurrentSince Sep 1, 2022 Accepting new patients
Central Dupage Physician Group CurrentSince Aug 26, 2020 Accepting new patients
Northwestern Medical Faculty Foundation CurrentSince Sep 1, 2022 Accepting new patients
Central Dupage Physician Group CurrentSince Aug 26, 2020 Accepting new patients

Locations

Dept 5777
Carol Stream, IL 60122

10350 Haligus Rd
Ste C
Huntley, IL 60142
Phone (312) 695-3800

11650 S State Route 47
Huntley, IL 60142
Phone (847) 802-7300

660 N Westmoreland Rd
#302
Lake Forest, IL 60045

4309 W Medical Center Dr
Ste B301
McHenry, IL 60050
Phone (847) 535-6083

4309 W Medical Center Dr
Ste B305
McHenry, IL 60050
Phone (847) 802-7400

4309 W Medical Center Dr
Ste A102
McHenry, IL 60050
Phone (815) 759-4323

515 Valley View Dr
Ste 201
Moline, IL 61265
Phone (312) 695-0870

1800 N Main St
Wheaton, IL 60187
Phone (630) 469-0045

Organizations & group practices 4

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

Hospital & facility affiliations 4

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1377475200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1599091200000",
    "number": "1033543129",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4309 W MEDICAL CENTER DR STE B305",
            "city": "MCHENRY",
            "state": "IL",
            "postal_code": "600508418",
            "telephone_number": "847-802-7400"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4309 W MEDICAL CENTER DR STE B305",
            "city": "MCHENRY",
            "state": "IL",
            "postal_code": "600508418",
            "telephone_number": "847-802-7400"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "10350 Haligus Rd Ste C",
            "address_purpose": "LOCATION",
            "city": "Huntley",
            "state": "IL",
            "postal_code": "601429545",
            "country_code": "US",
            "telephone_number": "847-802-7400",
            "fax_number": "847-802-7399",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "NICKLES",
        "first_name": "MAGALY",
        "credential": "APN",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2013-08-26",
        "last_updated": "2020-09-03",
        "certification_date": "2020-09-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "IL",
            "license": "041337837",
            "primary": false
        },
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "IL",
            "license": "209010594",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "LICENSE NUMBER",
            "identifier": "209-010594",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in McHenry, IL

Sources for this page

Verify at the official NPI Registry.