Individual provider Active NPI

Nicholas Counterman, PA-C

  • Physician Assistant
  • McHenry, IL
National Provider Identifier
1114616133
Registry record updated Nov 6, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
085009938 Issued in IL
Practice address
4309 W Medical Center Dr Ste B201
McHenry, IL 60050-8417
Phone
(847) 535-7271
Fax
(847) 802-7399
NPI assigned
May 4, 2023
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 6, 2023

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Surgical Physician Assistant 363AS0400X
Physician Assistant 363A00000X 085009938 IL Primary

Addresses

Primary practice location

4309 W Medical Center Dr Ste B201
McHenry, IL 60050-8417

Mailing address

4309 W Medical Center Dr Ste B201
McHenry, IL 60050-8417
Phone (847) 535-7271

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
I20230927003308 IL Practitioner - Physician Assistant 8022462811 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2023
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Northwestern Medical Faculty FoundationGroup PAC ID 4587576814, 4,386 clinicians

Practice addresses (Care Compare)

1000 N Westmoreland Rd
Pavillion B 3Rd FL
Lake Forest, IL 60045-1659
Phone (847) 535-8500

1000 Westmoreland Rd
Lake Forest, IL 60045-1659
Phone (847) 234-5600

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

4309 W Medical Ctr Dr
Suite A200
McHenry, IL 60050-8437
Phone (815) 759-8070

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

600 N Westmoreland Rd
Suite 1100
Lake Forest, IL 60045-1659
Phone (847) 535-9510

660 N Westmoreland Rd
Lake Forest, IL 60045-1659
Phone (847) 234-5600

660 N Westmoreland Rd
302 Lake Forest OBGYN
Lake Forest, IL 60045-1673
Phone (312) 926-6146

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

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
Physician Assistant

State licenses

LicenseStateTypeSpecialty
085009938ILMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Northwestern Medical Faculty Foundation CurrentSince Sep 14, 2023 Accepting new patients
Northwestern Medical Faculty Foundation CurrentSince Sep 14, 2023 Accepting new patients
Central Dupage Physician Group Past Accepting new patients

Locations

Dept 5777
Carol Stream, IL 60122

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

1000 N Westmoreland Rd
#3
Lake Forest, IL 60045
Phone (847) 535-8500

660 N Westmoreland Rd
#302
Lake Forest, IL 60045

4309 W Medical Center Dr
Ste B201
McHenry, IL 60050
Phone (847) 535-7271

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

Organizations & group practices 3

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 2

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": "1683158400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1699228800000",
    "number": "1114616133",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4309 W MEDICAL CENTER DR STE B201",
            "city": "MCHENRY",
            "state": "IL",
            "postal_code": "600508417",
            "telephone_number": "847-535-7271",
            "fax_number": "847-802-7399"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4309 W MEDICAL CENTER DR STE B201",
            "city": "MCHENRY",
            "state": "IL",
            "postal_code": "600508417",
            "telephone_number": "847-535-7271",
            "fax_number": "847-802-7399"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "COUNTERMAN",
        "first_name": "NICHOLAS",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2023-05-04",
        "last_updated": "2023-11-06",
        "certification_date": "2023-11-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AS0400X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Surgical",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "IL",
            "license": "085009938",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in McHenry, IL

Sources for this page

Verify at the official NPI Registry.