Individual provider Active NPI

Nicholas Dilly

  • Acute Care Nurse Practitioner
  • Kalamazoo, MI
National Provider Identifier
1194685636
Registry record updated Feb 18, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Acute Care Nurse PractitionerTaxonomy code 363LA2100X
License
4704394320 Issued in MI
Practice address
1521 Gull Rd
Kalamazoo, MI 49048-1640
Phone
(269) 226-7000
NPI assigned
Nov 17, 2025
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 18, 2026

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Acute Care Nurse Practitioner 363LA2100X 4704394320 MI Primary

Addresses

Primary practice location

1521 Gull Rd
Kalamazoo, MI 49048-1640

Mailing address

3245 Health Dr Ste 100
Granger, IN 46530-1380

Other identifiers 1

IdentifierTypeStateIssuer
1194685636MedicaidMI

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MI
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
I20260220001996 MI Practitioner - Nurse Practitioner 0042791758 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
University of Michigan Medical School, 2025
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Ascension Medical Group PromedGroup PAC ID 7315856077, 255 clinicians

Practice addresses (Care Compare)

1521 Gull Rd
Kalamazoo, MI 49048-1640
Phone (269) 226-5165

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
4704394320MIMDAcute Care Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Ascension Medical Group Promed Acute Care CurrentSince Mar 8, 2026 Accepting new patients
Promed Healthcare CurrentSince Mar 8, 2026 Accepting new patients
Ascension Medical Group Promed Past Accepting new patients

Locations

3245 Health Dr
Ste 100
Granger, IN 46530
Phone (574) 647-2129

1521 Gull Rd
Kalamazoo, MI 49048
Phone (269) 226-5165

7901 Angling Rd
Portage, MI 49024
Phone (269) 324-8405

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 1

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": "1763337600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1771372800000",
    "number": "1194685636",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3245 HEALTH DR STE 100",
            "city": "GRANGER",
            "state": "IN",
            "postal_code": "465301380"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1521 GULL RD",
            "city": "KALAMAZOO",
            "state": "MI",
            "postal_code": "490481640",
            "telephone_number": "269-226-7000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DILLY",
        "first_name": "NICHOLAS",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2025-11-17",
        "last_updated": "2026-02-18",
        "certification_date": "2026-02-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LA2100X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Acute Care",
            "state": "MI",
            "license": "4704394320",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1194685636",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Kalamazoo, MI

Sources for this page

Verify at the official NPI Registry.