Nicole R Mott, DO

Primary specialty

Emergency Medicine PhysicianTaxonomy code 207P00000X

License

036112820 Issued in IL

Practice address

17495 La Grange Rd
Tinley Park, IL 60487-7581

Phone

(708) 364-3163

Fax

(708) 226-1969

NPI assigned

Jul 16, 2006

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Other names 1

• Nicole R Zendejas Former name

Electronic endpoints 1

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: Yes

Green means eligible to order or refer.

Enrollment records 1

Specialty

Emergency Medicine

Education

Other, 2002

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)

Hospital & facility affiliations

• Northwestern Medicine Central Dupage Hospital Hospital, Winfield, IL, CCN 140242
• Northwestern Memorial Hospital Hospital, Chicago, IL, CCN 140281

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Osteopathy

State licenses

Practice roles

Locations (25 of 37)

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.

• Northwestern Medical Faculty Foundation

  • Multi-Specialty Clinic/Center
  • Carol Stream, IL
  • NPI 1346235314
  Medicare reassignment Care Compare group NPD
• Dupage Medical Group LTD

  • Multi-Specialty Clinic/Center
  • Downers Grove, IL
  • NPI 1801833983
  Medicare reassignment NPD
• Ottawa Regional Hospital & Healthcare Center

  • General Acute Care Hospital
  • Ottawa, IL
  • NPI 1306971080
  Medicare reassignment NPD
• Rockford Health Physicians

  • Multi-Specialty Clinic/Center
  • Rockford, IL
  • NPI 1043242886
  Medicare reassignment NPD
• Dupage Medical Group LTD

  • Durable Medical Equipment & Medical Supplies
  • Glen Ellyn, IL
  • NPI 1760979447
  NPD
• Northwestern Medical Faculty Foundation

  • Durable Medical Equipment & Medical Supplies
  • Chicago, IL
  • NPI 1417718479
  NPD
• Ottawa Regional Hospital & Healthcare Center

  • Family Medicine Physician
  • Marseilles, IL
  • NPI 1558088203
  NPD
• Central Dupage Physician Group

  • Family Medicine Physician
  • Carol Stream, IL
  • NPI 1033149844
  NPD (past)
• Brown, Calvanese, Cameron LTD

  • Emergency Medicine Physician
  • Reno, NV
  • NPI 1275568479
  NPD (past)

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

• Central Dupage Hospital Association

  • General Acute Care Hospital
  • Winfield, IL
  • NPI 1003864810
  Care Compare affiliation
• Central Dupage Hospital Association

  • Psychiatric Hospital Unit
  • Winfield, IL
  • NPI 1740230895
  Care Compare affiliation
• Northwestern Memorial Hospital

  • General Acute Care Hospital
  • Chicago, IL
  • NPI 1497859649
  Care Compare affiliation

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

{
    "created_epoch": "1153008000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1698019200000",
    "number": "1093732034",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "885 ROOSEVELT RD STE 100",
            "city": "GLEN ELLYN",
            "state": "IL",
            "postal_code": "601376141",
            "telephone_number": "630-384-6200",
            "fax_number": "630-384-6229"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "17495 LA GRANGE RD",
            "city": "TINLEY PARK",
            "state": "IL",
            "postal_code": "604877581",
            "telephone_number": "708-364-3163",
            "fax_number": "708-226-1969"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "885 Roosevelt Rd Ste 100",
            "address_purpose": "LOCATION",
            "city": "Glen Ellyn",
            "state": "IL",
            "postal_code": "60137",
            "country_code": "US",
            "telephone_number": "630-384-6200",
            "fax_number": "630-384-6229",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "MOTT",
        "first_name": "NICOLE",
        "middle_name": "R",
        "credential": "DO",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-07-16",
        "last_updated": "2023-10-23",
        "certification_date": "2023-10-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "IL",
            "license": "36112820",
            "primary": false
        },
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "IL",
            "license": "036112820",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "nmott249300@dulyhealthandcare.direct-ci.com",
            "affiliation": "N",
            "use": "DIRECT",
            "useDescription": "Direct",
            "address_1": "17495 La Grange Rd",
            "city": "Tinley Park",
            "state": "IL",
            "country_code": "US",
            "postal_code": "604877581",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "first_name": "NICOLE",
            "last_name": "ZENDEJAS",
            "middle_name": "R",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

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• Lindsey Motykowski, M.H.S. CCC-SLP
• Mount Carmel Services, Inc
• Tara Moustis, D.D.S.
• MSM Healthcare Solutions, Inc
• MSM Home Healthcare Solutions, Inc.

• Emergency Medicine Physician in Tinley Park, IL
• Providers in Tinley Park, IL by specialty
• Emergency Medicine Physician in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 23, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.