NPIMap

Individual provider Active NPI

Nicholas Alexander Borm, M.D.

  • Emergency Medicine Physician
  • Chicago, IL
National Provider Identifier
1205272739
Registry record updated May 7, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Emergency Medicine PhysicianTaxonomy code 207P00000X
License
A124654 Issued in CA
Practice address
211 E Ontario St Ste 300
Chicago, IL 60611-3284
Phone
(312) 694-7000
NPI assigned
May 10, 2013
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on May 7, 2024

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Emergency Medicine Physician 207P00000X A124654 CA Primary

Addresses

Primary practice location

211 E Ontario St Ste 300
Chicago, IL 60611-3284

Mailing address

211 E Ontario St Ste 300
Chicago, IL 60611-3284

Electronic endpoints 1

TypeEndpointUseAffiliation
SOAP URL https://careepicwest.kp.org:14430/Interconnect-prodcalgateway/wcf/epic.community.hie/xcpdrespondinggatewaysync.svc/scalceq Health Information Exchange (HIE) Southern California Permanente Medical Group

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20130828000190 CA Practitioner - Emergency Medicine 1658514336 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Emergency Medicine
Education
Morehouse School of Medicine, 2009
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Valley Presbyterian Emergency Medical AssociatesGroup PAC ID 1951308105, 10 clinicians

Practice addresses (Care Compare)

15107 Vanowen St
Van Nuys, CA 91405-4542
Phone (818) 902-2990

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
100 of 100Reported as group
Quality
92.74
Improvement activities
40

Merit-based Incentive Payment System (MIPS)

Final score
92.41 of 100Reported as group
Quality
79.31
Improvement activities
40

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

Practice roles

OrganizationSpecialtyStatusNew patients
Sherman Oaks Emergency Medical Associates Emergency Medicine CurrentSince Jul 22, 2013 Accepting new patients
Telemedicine365 Inc Emergency Medicine CurrentSince Jan 1, 2021 Accepting new patients
Valley Presbyterian Emergency Medical Associates Emergency Medicine CurrentSince Jul 22, 2013 Accepting new patients

Locations

15107 Vanowen St
Van Nuys, CA 91405
Phone (818) 782-6600

4929 Van Nuys Blvd
Van Nuys, CA 91403
Phone (818) 907-4561

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 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": "1368144000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1715040000000",
    "number": "1205272739",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "211 E ONTARIO ST STE 300",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606113284"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "211 E ONTARIO ST STE 300",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606113284",
            "telephone_number": "312-694-7000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BORM",
        "first_name": "NICHOLAS",
        "middle_name": "ALEXANDER",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2013-05-10",
        "last_updated": "2024-05-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "CA",
            "license": "A124654",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "SOAP",
            "endpointTypeDescription": "SOAP URL",
            "endpoint": "https://careepicwest.kp.org:14430/Interconnect-prodcalgateway/wcf/epic.community.hie/xcpdrespondinggatewaysync.svc/scalceq",
            "affiliation": "Y",
            "endpointDescription": "Carequality",
            "affiliationName": "Southern California Permanente Medical Group",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "C-CDA",
            "address_1": "5601 De Soto Ave",
            "city": "Woodland Hills",
            "state": "CA",
            "country_code": "US",
            "postal_code": "913676701",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Chicago, IL

Sources for this page

Verify at the official NPI Registry.