Gregory Alan Nichols, RN, MSN, FNP-BC

Primary specialty

Nurse PractitionerTaxonomy code 363L00000X

License

209008721 Issued in IL

Practice address

1 Westbrook Corporate Ctr Ste 300
Westchester, IL 60154-5709

Phone

(866) 949-0108

NPI assigned

Mar 28, 2011

Last updated

Apr 18, 2022By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Other identifiers 1

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

Medicare enrollment (NPD)

Enrolled

Credentials

Master of Science - Nursing, Nurse Practitioner, Registered Nurse

State licenses

Practice roles

Interoperability endpoints

• Direct secure messaging: ms_gnicho11@landmarkhealth-direct.org

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Avanti Medical Group of Illinois LLC

  • Clinic/Center
  • Wheaton, IL
  • NPI 1609185875
  NPD (past)

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

{
    "created_epoch": "1301270400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1650240000000",
    "number": "1669771861",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2115 WATER CHASE DR",
            "city": "NEW LENOX",
            "state": "IL",
            "postal_code": "604514813",
            "telephone_number": "815-325-3978"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1 WESTBROOK CORPORATE CTR STE 300",
            "city": "WESTCHESTER",
            "state": "IL",
            "postal_code": "601545709",
            "telephone_number": "866-949-0108"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "8525 183rd St Ste M",
            "address_purpose": "LOCATION",
            "city": "Tinley Park",
            "state": "IL",
            "postal_code": "604873702",
            "country_code": "US",
            "telephone_number": "708-781-4400",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "16547 W 159th St",
            "address_purpose": "LOCATION",
            "city": "Lockport",
            "state": "IL",
            "postal_code": "604417900",
            "country_code": "US",
            "telephone_number": "815-834-9075",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "NICHOLS",
        "first_name": "GREGORY",
        "middle_name": "ALAN",
        "name_prefix": "Mr.",
        "credential": "RN, MSN, FNP-BC",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2011-03-28",
        "last_updated": "2022-04-18",
        "certification_date": "2022-04-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "IL",
            "license": "209.008721",
            "primary": false
        },
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "IL",
            "license": "209008721",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NPI",
            "identifier": "1770860124",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Nurse Practitioner in Westchester, IL
• Providers in Westchester, IL by specialty
• Nurse Practitioner in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 18, 2022; 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.