Individual provider Active NPI

Nicole M. Haberkorn, NP

  • Nurse Practitioner
  • Chicago, IL
National Provider Identifier
1205504529
Registry record updated Jan 17, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nurse PractitionerTaxonomy code 363L00000X
License
209.023729 Issued in IL
Practice address
675 N Saint Clair St Ste 21-100
Chicago, IL 60611-5970
Phone
(312) 695-0990
Fax
(312) 695-1106
NPI assigned
Sep 1, 2021
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jan 17, 2022

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Nurse Practitioner 363L00000X 209.023729 IL Primary

Addresses

Primary practice location

675 N Saint Clair St Ste 21-100
Chicago, IL 60611-5970

Mailing address

675 N Saint Clair St Ste 21-100
Chicago, IL 60611-5970
Phone (312) 695-0990

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
I20211020000592 IL Practitioner - Nurse Practitioner 2567850845 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2021
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Ahp Specialty Care NFPGroup PAC ID 9931491107, 32 clinicians

Practice addresses (Care Compare)

1 Salt Creek LN
Suite 100
Hinsdale, IL 60521-2971
Phone (630) 286-5500

Hospital & facility affiliations

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
209.023729ILMDNurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Ahp Specialty Care NFP CurrentSince May 11, 2025 Accepting new patients

Locations

3815 Highland Ave
Downers Grove, IL 60515
Phone (630) 275-5900

1 Salt Creek Ln
Ste 100
Hinsdale, IL 60521
Phone (630) 286-5500

1 Salt Creek Ln
Hinsdale, IL 60521
Phone (630) 286-5500

Organizations & group practices 1

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 6

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": "1630454400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1642377600000",
    "number": "1205504529",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "675 N SAINT CLAIR ST STE 21-100",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606115970",
            "telephone_number": "312-695-0990",
            "fax_number": "312-695-1106"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "675 N SAINT CLAIR ST STE 21-100",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606115970",
            "telephone_number": "312-695-0990",
            "fax_number": "312-695-1106"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HABERKORN",
        "first_name": "NICOLE",
        "middle_name": "M.",
        "credential": "NP",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2021-09-01",
        "last_updated": "2022-01-17",
        "certification_date": "2022-01-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "IL",
            "license": "209.023729",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Chicago, IL

Sources for this page

Verify at the official NPI Registry.