Individual provider Active NPI

Nikki Bharucha

  • Physician Assistant
  • Naperville, IL
National Provider Identifier
1780357442
Registry record updated Mar 24, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
085009407 Issued in IL
Practice address
1948 Three Farms Ave
Naperville, IL 60540-1105
Phone
(732) 781-6454
NPI assigned
Jul 28, 2021
Last updated
Mar 24, 2023By the provider in NPPES
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Mar 24, 2023

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X 085009407 IL Primary
Student in an Organized Health Care Education/Training Program 390200000X

Addresses

Primary practice location

1948 Three Farms Ave
Naperville, IL 60540-1105

Mailing address

28262 Diehl Rd Apt 318
Warrenville, IL 60555-3877
Phone (732) 781-6454

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address nbharucha256456@direct.edward.org Direct

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
I20230120002678 IL Practitioner - Physician Assistant 1557732906 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2022
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)

155 E Brush Hill Rd
Elmhurst, IL 60126-5658
Phone (331) 221-0096

177 E Brush Hill Rd
Elmhurst, IL 60126-5658
Phone (630) 646-6020

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

Practice roles

OrganizationSpecialtyStatusNew patients
Endeavor Health Medical Group CurrentSince Dec 20, 2023 Accepting new patients
Edward Health Ventures CurrentSince Jan 23, 2023 Accepting new patients
Edward Health Ventures CurrentSince Jan 23, 2023 Accepting new patients

Locations

9532 Eagle Way
Chicago, IL 60678

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

2650 Ridge Ave
#1223
Evanston, IL 60201
Phone (847) 982-3172

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

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

Interoperability endpoints

  • Direct secure messaging: nbharucha256456@direct.edward.org

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 2

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": "1627430400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1679616000000",
    "number": "1780357442",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "28262 DIEHL RD APT 318",
            "city": "WARRENVILLE",
            "state": "IL",
            "postal_code": "605553877",
            "telephone_number": "732-781-6454"
        },
        {
            "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": "732-781-6454"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BHARUCHA",
        "first_name": "NIKKI",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2021-07-28",
        "last_updated": "2023-03-24",
        "certification_date": "2023-03-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "IL",
            "license": "085009407",
            "primary": true
        },
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "nbharucha256456@direct.edward.org",
            "affiliation": "N",
            "use": "DIRECT",
            "useDescription": "Direct",
            "address_1": "1948 Three Farms Ave",
            "city": "Naperville",
            "state": "IL",
            "country_code": "US",
            "postal_code": "605401105",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Naperville, IL

Sources for this page

Verify at the official NPI Registry.