Kelli Nickols, APN

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

209008896 Issued in IL

Practice address

1 Ingalls Dr
Wyman Gordon Pavilion- Home Care Division
Harvey, IL 60426-3558

Phone

(708) 915-4649

Fax

(708) 915-6357

NPI assigned

Oct 11, 2011

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

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

Specialty

Nurse Practitioner

Education

Other, 2010

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

University of ChicagoGroup PAC ID 7719899426, 1,674 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• The University of Chicago Medical Center Hospital, Chicago, IL, CCN 140088

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: knickolsapn79840@uchospital.direct-ci.com

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.

• University of Chicago

  • Multi-Specialty Clinic/Center
  • Chicago, IL
  • NPI 1821048786
  Medicare reassignment Care Compare group NPD
• Advanced Metrorehab Inc.

  • Physical Medicine & Rehabilitation Physician
  • Chicago, IL
  • NPI 1376676817
  Medicare reassignment NPD
• The University of Chicago Medical Center

  • General Acute Care Hospital
  • Chicago, IL
  • NPI 1033218128
  Medicare reassignment NPD
• The University of Chicago Medical Center

  • Community/Retail Pharmacy
  • Calumet City, IL
  • NPI 1255895678
  NPD

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

• The University of Chicago Medical Center

  • General Acute Care Hospital
  • Chicago, IL
  • NPI 1508956509
  Care Compare affiliation

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

{
    "created_epoch": "1318291200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1352073600000",
    "number": "1578847489",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1 INGALLS DR",
            "address_2": "WYMAN GORDON PAVILION- HOME CARE DIVISION",
            "city": "HARVEY",
            "state": "IL",
            "postal_code": "604263558",
            "telephone_number": "708-915-4649",
            "fax_number": "708-915-6357"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1 INGALLS DR",
            "address_2": "WYMAN GORDON PAVILION- HOME CARE DIVISION",
            "city": "HARVEY",
            "state": "IL",
            "postal_code": "604263558",
            "telephone_number": "708-915-4649",
            "fax_number": "708-915-6357"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "NICKOLS",
        "first_name": "KELLI",
        "credential": "APN",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2011-10-11",
        "last_updated": "2012-11-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "IL",
            "license": "209008896",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Neurology Associates LTD.
• New Choice Intervention, Inc.
• New Choice Intervention, Inc.
• Latesha Lillie Newson, MSW, LCSW
• Paul G Ngumi, M.D.
• Gwendolyn Renee Norman, OTR
• Christina Lynn Norris, FNP-BC
• Massoud Nourbash, M.D.
• Renata Nowik, PHYSICAL THERAPIST
• O and R Delivery LLC

• Family Nurse Practitioner in Harvey, IL
• Providers in Harvey, IL by specialty
• Family Nurse Practitioner in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 5, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.