Individual provider Active NPI

Tara Cole Nikodem, PA-C

  • Surgical Physician Assistant
  • Naperville, IL
National Provider Identifier
1720322654
Registry record updated Mar 24, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Surgical Physician AssistantTaxonomy code 363AS0400X
License
085004540 Issued in IL
Practice address
1948 Three Farms Ave
Naperville, IL 60540-1105
Phone
(630) 355-5633
NPI assigned
Nov 15, 2012
Last updated
Mar 24, 2026By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 24, 2026

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Surgical Physician Assistant 363AS0400X 085004540 IL Primary
Physician Assistant 363A00000X 085.004540 IL

Addresses

Primary practice location

1948 Three Farms Ave
Naperville, IL 60540-1105

Mailing address

2650 Ridge Ave Ste 1223
Evanston, IL 60201-1700
Phone (847) 982-3363

Other practice location 1

211 E Ontario St
Suite 200
Chicago, IL 60611-3468
Phone (312) 694-7000

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
I20130501000289 IL Practitioner - Physician Assistant 8022255595 Reassigns benefits to 6 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2012
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Endeavor Health Medical GroupGroup PAC ID 2163334699, 3,330 clinicians

Practice addresses (Care Compare)

1948 Three Farms Ave
Naperville, IL 60540-1105
Phone (630) 355-5668

2650 Ridge Ave
Evanston, IL 60201-1700

801 S Washington St
Naperville, IL 60540-7430
Phone (630) 527-5197

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
84.9 of 100Reported as group
Quality
75.91
Promoting interoperability
99
Improvement activities
40
Cost
74.6

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

State licenses

LicenseStateTypeSpecialty
085.004540ILMDPhysician Assistant
085004540ILMDSurgical Physician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Edward Hospital CurrentSince Jul 30, 2023 Accepting new patients
Edward Health Ventures CurrentSince Dec 1, 2022 Accepting new patients
Endeavor Health Medical Group CurrentSince Nov 1, 2023 Accepting new patients
Northwestern Medical Faculty Foundation CurrentSince Jul 5, 2016 Accepting new patients
Northwestern Medical Faculty Foundation CurrentSince Jul 5, 2016 Accepting new patients
Elmhurst Memorial Hospital CurrentSince Jul 30, 2023 Accepting new patients
Dupage Medical Group LTD CurrentSince Dec 10, 2012 Accepting new patients
Dupage Medical Group LTD CurrentSince Dec 10, 2012 Accepting new patients
Edward Hospital CurrentSince Jul 30, 2023 Accepting new patients
Edward Health Ventures CurrentSince Dec 1, 2022 Accepting new patients
Central Dupage Physician Group Past Accepting new patients

Locations

303 W Lake St
Ste 301
Addison, IL 60101
Phone (331) 221-1650

231 S Gary Ave
Ste 100
Bloomingdale, IL 60108
Phone (630) 893-9600

Dept 5777
Carol Stream, IL 60122

211 E Ontario St
Ste 200
Chicago, IL 60611
Phone (312) 694-7000

251 E Huron St
#16
Chicago, IL 60611

680 N Lake Shore Dr
Ste 1000
Chicago, IL 60611
Phone (312) 695-4022

9532 Eagle Way
Chicago, IL 60678

2650 Ridge Ave
Evanston, IL 60201
Phone (847) 570-1206

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

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

660 N Westmoreland Rd
#302
Lake Forest, IL 60045

3033 Ogden Ave
Ste 101
Lisle, IL 60532
Phone (630) 646-6200

120 Spalding Dr
Ste 101
Naperville, IL 60540
Phone (630) 527-7730

120 Spalding Dr
Ste 310
Naperville, IL 60540
Phone (630) 527-5575

1948 Three Farms Ave
Naperville, IL 60540
Phone (630) 355-5633

801 S Washington St
Naperville, IL 60540
Phone (312) 355-0450

6701 US Highway 34
Oswego, IL 60543
Phone (630) 646-4200

870 N Milwaukee Ave
Vernon Hills, IL 60061
Phone (847) 475-2273

1800 N Main St
Wheaton, IL 60187
Phone (630) 469-0045

Interoperability endpoints

  • FHIR API: https://fhirprd.edward.org/fhirprd/api/FHIR/R4/
  • Direct secure messaging: tcolenikodem255099@direct.edward.org

Organizations & group practices 12

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.

Hospital & facility affiliations 1

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": "1352937600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1774310400000",
    "number": "1720322654",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2650 RIDGE AVE STE 1223",
            "city": "EVANSTON",
            "state": "IL",
            "postal_code": "602011700",
            "telephone_number": "847-982-3363"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1948 THREE FARMS AVE",
            "city": "NAPERVILLE",
            "state": "IL",
            "postal_code": "605401105",
            "telephone_number": "630-355-5633"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "211 E Ontario St",
            "address_2": "Suite 200",
            "address_purpose": "LOCATION",
            "city": "Chicago",
            "state": "IL",
            "postal_code": "606113468",
            "country_code": "US",
            "telephone_number": "312-694-7000",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "NIKODEM",
        "first_name": "TARA",
        "middle_name": "COLE",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2012-11-15",
        "last_updated": "2026-03-24",
        "certification_date": "2026-03-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AS0400X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Surgical",
            "state": "IL",
            "license": "085004540",
            "primary": true
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "IL",
            "license": "085.004540",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Naperville, IL

Sources for this page

Verify at the official NPI Registry.