Individual provider Active NPI

Nicole Aida Kafati, MD

  • Pediatrics Physician
  • Highland Park, IL
National Provider Identifier
1306334628
Registry record updated May 15, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatrics PhysicianTaxonomy code 208000000X
License
ME166260 Issued in FL
Practice address
777 Park Ave W
Highland Park, IL 60035-2433
Phone
(847) 570-2530
NPI assigned
Apr 23, 2018
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 15, 2024

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

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
Hospitalist Physician 208M00000X 036156549 IL
Student in an Organized Health Care Education/Training Program 390200000X
Pediatrics Physician 208000000X ME166260 FL Primary
Pediatrics Physician 208000000X 036156549 IL

Addresses

Primary practice location

777 Park Ave W
Highland Park, IL 60035-2433

Mailing address

345 E Ohio St Apt 2402
Chicago, IL 60611-4060
Phone (786) 449-4191

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: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20210527000710 IL Practitioner - HospitalistPractitioner - Pediatric Medicine 1759639594 Reassigns benefits to 1 organization

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
ME166260FLMDPediatrics Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Endeavor Health Medical Group Pediatrics CurrentSince May 18, 2021 Accepting new patients
Endeavor Health Medical Group CurrentSince May 18, 2021 Accepting new patients

Locations

9532 Eagle Way
Chicago, IL 60678

2650 Ridge Ave
Ste 2218A
Evanston, IL 60201
Phone (847) 503-4222

2650 Ridge Ave
Ste 1223
Evanston, IL 60201
Phone (847) 982-3175

777 Park Ave W
Highland Park, IL 60035
Phone (847) 480-3744

Interoperability endpoints

  • Direct secure messaging: nkafati17995@uihealth.direct-ci.com

Organizations & group practices 2

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.

NPI Registry JSON

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

{
    "created_epoch": "1524441600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1715731200000",
    "number": "1306334628",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "345 E OHIO ST APT 2402",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606114060",
            "telephone_number": "786-449-4191"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "777 PARK AVE W",
            "city": "HIGHLAND PARK",
            "state": "IL",
            "postal_code": "600352433",
            "telephone_number": "847-570-2530"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KAFATI",
        "first_name": "NICOLE",
        "middle_name": "AIDA",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2018-04-23",
        "last_updated": "2024-05-15",
        "certification_date": "2024-05-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208M00000X",
            "taxonomy_group": "",
            "desc": "Hospitalist",
            "state": "IL",
            "license": "036156549",
            "primary": false
        },
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "FL",
            "license": "ME166260",
            "primary": true
        },
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "IL",
            "license": "036156549",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Highland Park, IL

Sources for this page

Verify at the official NPI Registry.