Nicholas Brent Koch, AGPCNP-BC

Primary specialty

Primary Care Nurse PractitionerTaxonomy code 363LP2300X

License

209.028387 Issued in IL

Practice address

150 E Huron St Ste 1101
Chicago, IL 60611-2948

Phone

(312) 741-8554

Fax

(312) 216-1779

NPI assigned

Oct 5, 2023

Last updated

Nov 23, 2024By 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

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

State licenses

Practice roles

Locations

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.

• Near North Health Service Corporation

  dba Winfield Moody Health Center

  • Federally Qualified Health Center (FQHC)
  • Chicago, IL
  • NPI 1821079088
  Medicare reassignment NPD
• Near North Health Service Corporation

  dba Near North Health Family Health Center at Oakwood Shores

  • Federally Qualified Health Center (FQHC)
  • Chicago, IL
  • NPI 1740166255
  NPD
• Near North Health Service Corporation

  • Federally Qualified Health Center (FQHC)
  • Chicago, IL
  • NPI 1952035123
  NPD

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

{
    "created_epoch": "1696464000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1732320000000",
    "number": "1750162780",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "150 E HURON ST STE 1101",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606112948",
            "telephone_number": "312-741-8554",
            "fax_number": "312-216-1779"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "150 E HURON ST STE 1101",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606112948",
            "telephone_number": "312-741-8554",
            "fax_number": "312-216-1779"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KOCH",
        "first_name": "NICHOLAS",
        "middle_name": "BRENT",
        "name_prefix": "Mr.",
        "credential": "AGPCNP-BC",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2023-10-05",
        "last_updated": "2024-11-23",
        "certification_date": "2024-11-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LG0600X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Gerontology",
            "state": "IL",
            "license": "209.028387",
            "primary": false
        },
        {
            "code": "363LP2300X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Primary Care",
            "state": "IL",
            "license": "209.028387",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Kaila Rose Koch
• Karen A Koch, PSYD.
• Kelly Diana Koch, MS, MOTR/L
• Kendall H Koch, D.D.S.
• Matthew J. Koch, MD
• Rosemarie Eleana Koch, RPH
• Shea Lynn Koch, PHARMD
• Thomas Michael Koch, PA-C
• William Koch
• Mallory Elizabeth Kocher, DDS

• Primary Care Nurse Practitioner in Chicago, IL
• Providers in Chicago, IL by specialty
• Primary Care Nurse Practitioner in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 23, 2024; 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.