Diane Nickless

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

149013771 Issued in IL

Practice address

11114 Karen Dr
Orland Park, IL 60467-4482

Phone

(773) 791-9884

NPI assigned

May 10, 2017

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in IL

Eligible to order & refer

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

Green means eligible to order or refer.

Enrollment records 1

Specialty

Clinical Social Worker

Education

Other, 2007

Medicare assignment

May accept Medicare assignment

Telehealth

Offers telehealth services

Practice addresses (Care Compare)

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.

• Heart Source Therapy

  • Professional Counselor
  • Frankfort, IL
  • NPI 1902146202
  NPD (past)
• Heartsource Therapy PC

  • Clinical Social Worker
  • Frankfort, IL
  • NPI 1215314414
  NPD (past)

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

{
    "created_epoch": "1494374400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1494374400000",
    "number": "1891221974",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11114 KAREN DR",
            "city": "ORLAND PARK",
            "state": "IL",
            "postal_code": "604674482",
            "telephone_number": "773-791-9884"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11114 KAREN DR",
            "city": "ORLAND PARK",
            "state": "IL",
            "postal_code": "604674482",
            "telephone_number": "773-791-9884"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "NICKLESS",
        "first_name": "DIANE",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2017-05-10",
        "last_updated": "2017-05-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "IL",
            "license": "149013771",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Susan Ann Nevin, M.ED.
• New Life Chiropractic
• Newsome & Associates, LTD.
• Nexus Chiropractic, P.C.
• Chrysogonus Ngongchia
• Tiffany Nickson, LPN
• Edward Niedbalec, RPH
• Magdalena Agata Niemiec, RD
• Dallal Nijem
• Sai Ram Nimmagadda, M.D.

• Clinical Social Worker in Orland Park, IL
• Providers in Orland Park, IL by specialty
• Clinical Social Worker in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 10, 2017; 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.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.