John Thomas Nichols, DMD

Primary specialty

DentistTaxonomy code 122300000X

License

12009437A Issued in IN

Practice address

775 Waukegan Rd
Suite 200
Deerfield, IL 60015-4342

Phone

(800) 317-0711

Fax

(800) 434-7113

NPI assigned

Jan 17, 2006

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in KY

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

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.

• Primesource Healthcare Systems, Inc.

  • Podiatrist
  • Buffalo Grove, IL
  • NPI 1497704126

  Dentist

  NPD (past)
• Primesource Healthcare Systems, Inc.

  • Durable Medical Equipment & Medical Supplies
  • Columbus, OH
  • NPI 1801008644
  NPD (past)

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

{
    "created_epoch": "1137456000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1210291200000",
    "number": "1821077900",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "403 CHERRYWOOD RD",
            "city": "LOUISVILLE",
            "state": "KY",
            "postal_code": "402072101",
            "telephone_number": "502-897-7422"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "775 WAUKEGAN RD",
            "address_2": "SUITE 200",
            "city": "DEERFIELD",
            "state": "IL",
            "postal_code": "600154342",
            "telephone_number": "800-317-0711",
            "fax_number": "800-434-7113"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "NICHOLS",
        "first_name": "JOHN",
        "middle_name": "THOMAS",
        "name_prefix": "Dr.",
        "credential": "DMD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-01-17",
        "last_updated": "2008-05-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "IN",
            "license": "12009437A",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "200512620",
            "state": "IN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Lauren Nevoral
• New Leaf Counseling Group LLC
• Christine Nguyen
• Tracy Thanh Nguyen
• Van Thanh Nguyen, PHARM.D.
• Diane Nitzki-George, PHARMD
• Morgan D Nixon, PA-C
• Sivana Nolan
• Norman Chapman M D & Associates S C
• North Shore Academic Solutions

• Dentist in Deerfield, IL
• Providers in Deerfield, IL by specialty
• Dentist in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 9, 2008; 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.