NPIMap

Individual provider Active NPI

Nicholas Cho Ahn, M.D.

  • Internal Medicine Physician
  • Springfield, IL
National Provider Identifier
1376983346
Registry record updated Jun 5, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
036-141124 Issued in IL
Practice address
751 N Rutledge St
Suite 1100
Springfield, IL 62702
Phone
(217) 545-8000
Fax
(217) 545-4735
NPI assigned
Jul 5, 2013
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 5, 2018

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X 4301114315 MI
Psychiatry Physician 2084P0800X 125.064175 IL
Internal Medicine Physician 207R00000X 036-141124 IL Primary

Addresses

Primary practice location

751 N Rutledge St
Suite 1100
Springfield, IL 62702

Mailing address

PO Box 19648
Springfield, IL 62794-9648
Phone (217) 545-8000

Other practice location 1

5629 Stadium Dr Ste B
Kalamazoo, MI 49009-1952
Phone (269) 544-3270

Other identifiers 1

IdentifierTypeStateIssuer
036141124MedicaidIL

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in PA
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
I20230227003063 PA Practitioner - Internal Medicine 7719272400 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Internal Medicine
Education
Michigan State University College of Human Medicine, 2013
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

358 Hamlin Hwy
Lake Ariel, PA 18436-9382
Phone (570) 689-2242

543 Easton Tpke
Lake Ariel, PA 18436-4718
Phone (570) 689-9965

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
89.17 of 100Reported as apm
Quality
78.34
Promoting interoperability
100
Improvement activities
40

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
036-141124ILMDInternal Medicine Physician
125.064175ILMDPsychiatry Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Wayne Memorial Community Health Centers CurrentSince Aug 18, 2025 Accepting new patients
Wayne Memorial Community Health Centers Internal Medicine CurrentSince Aug 18, 2025 Accepting new patients
Wayne Memorial Community Health Centers Internal Medicine Past Accepting new patients

Locations

150 Brooklyn St
Carbondale, PA 18407
Phone (570) 282-2031

601 Park St
Honesdale, PA 18431
Phone (570) 253-8100

543 Easton Tpke
Ste 105
Lake Ariel, PA 18436
Phone (570) 689-4670

412 Como Rd
Lake Como, PA 18437
Phone (570) 775-7100

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 11

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": "1372982400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1528156800000",
    "number": "1376983346",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 19648",
            "city": "SPRINGFIELD",
            "state": "IL",
            "postal_code": "627949648",
            "telephone_number": "217-545-8000",
            "fax_number": "217-545-4735"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "751 N RUTLEDGE ST",
            "address_2": "SUITE 1100",
            "city": "SPRINGFIELD",
            "state": "IL",
            "postal_code": "62702",
            "telephone_number": "217-545-8000",
            "fax_number": "217-545-4735"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "5629 Stadium Dr Ste B",
            "address_purpose": "LOCATION",
            "city": "Kalamazoo",
            "state": "MI",
            "postal_code": "490091952",
            "country_code": "US",
            "telephone_number": "269-544-3270",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "AHN",
        "first_name": "NICHOLAS",
        "middle_name": "CHO",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2013-07-05",
        "last_updated": "2018-06-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "MI",
            "license": "4301114315",
            "primary": false
        },
        {
            "code": "2084P0800X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "IL",
            "license": "125.064175",
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "IL",
            "license": "036-141124",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "036141124",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Springfield, IL

Sources for this page

Verify at the official NPI Registry.