Individual provider Active NPI

John Nick Nikitas, MD

  • Internal Medicine Physician
  • Evanston, IL
National Provider Identifier
1730709171
Registry record updated Jul 19, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
125.075700 Issued in IL
Practice address
2650 Ridge Ave Ste 1304
Evanston, IL 60201-1700
Phone
(847) 570-4789
NPI assigned
Apr 24, 2020
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 19, 2020

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X 125.075700 IL Primary

Addresses

Primary practice location

2650 Ridge Ave Ste 1304
Evanston, IL 60201-1700

Mailing address

180 Harvester Dr Ste 110
Burr Ridge, IL 60527-6686
Phone (773) 702-1150

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in PA
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
I20250806000413 PA Practitioner - Radiation Oncology 6002239084 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Radiation Oncology
Education
Other, 2020
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
University of Penn-Medical GroupGroup PAC ID 6204730955, 3,433 clinicians

Practice addresses (Care Compare)

3400 Spruce St
Philadelphia, PA 19104-4238
Phone (215) 662-3000

Hospital & facility affiliations

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
University of Penn-Medical Group CurrentSince Sep 1, 2025 Accepting new patients
University of Penn-Medical Group CurrentSince Sep 1, 2025 Accepting new patients
University of Penn-Medical Group Current Accepting new patients
University of Penn - Medical Group Past Accepting new patients

Locations

1001 Chesterbrook Blvd
Berwyn, PA 19312
Phone (610) 576-7500

599 W State St
Ste 103
Doylestown, PA 18901
Phone (267) 880-2710

3400 Convention Ave
Philadelphia, PA 19104
Phone (215) 662-2300

145 King of Prussia Rd
#G101N
Wayne, PA 19087

701 E Marshall St
West Chester, PA 19380
Phone (610) 431-5000

800 Spruce St
William Penn Annex West, PA 19107
Phone (215) 829-3867

Organizations & group practices 4

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 3

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": "1587686400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1595116800000",
    "number": "1730709171",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "180 HARVESTER DR STE 110",
            "city": "BURR RIDGE",
            "state": "IL",
            "postal_code": "605276686",
            "telephone_number": "773-702-1150"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2650 RIDGE AVE STE 1304",
            "city": "EVANSTON",
            "state": "IL",
            "postal_code": "602011700",
            "telephone_number": "847-570-4789"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "NIKITAS",
        "first_name": "JOHN",
        "middle_name": "NICK",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2020-04-24",
        "last_updated": "2020-07-19",
        "certification_date": "2020-07-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "IL",
            "license": "125.075700",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Evanston, IL

Sources for this page

Verify at the official NPI Registry.