NIRALI J GHIA MD
NPI 1366492555
Obstetrics & Gynecology in Elmhurst, IL

Q: What is Nirali Ghia's NPI number?

The NPI number for Nirali Ghia is 1366492555. It was assigned to this individual provider in the NPPES registry on May 11, 2006.

Q: What is Nirali Ghia's specialty?

The primary specialty registered for this NPI is Obstetrics & Gynecology with taxonomy code 207V00000X.

Q: When was this NPI record last updated?

The NPPES record for Nirali Ghia was last updated on May 24, 2021. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 5 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.

Active since May 11, 2006PECOS EnrolledAccepts Medicare Assignment

91.35/100

CMS Quality Rating

1200 S YORK ST STE 2000, ELMHURST, IL 60126(331) 221-9002(331) 221-2749 Get Directions Write a Review

NPPES record last updated: May 24, 2021. Verified against the NPPES registry weekly; last sync: October 18, 2026.

On this page

About Nirali J Ghia Md NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

NIRALI J GHIA MD (NPI 1366492555) is an individual obstetrics & gynecology provider in Elmhurst, Illinois, licensed in Illinois (036100496) and active in the NPI registry since May 2006. She is enrolled in Medicare PECOS, is affiliated with Elmhurst Memorial Hospital, and is a graduate of Northwestern University Feinberg Medical School (1995).

NPPES Registry Identity

NPI1366492555

Entity TypeIndividualFemale

Primary Taxonomy207V00000X

Provider Legal NameNIRALI J GHIACredential: MD

Location Address1200 S YORK ST STE 2000Elmhurst, IL 60126-5634

Mailing Address4201 Winfield Rd Fl 4Warrenville, IL 60555-4025 · (331) 221-6377 · Fax (331) 221-2357

Phone(331) 221-9002

Fax(331) 221-2749

Sole ProprietorNo

Medical School CMSNorthwestern University Feinberg Medical SchoolGraduated 1995

Enumeration DateMay 11, 2006

Last NPPES UpdateMay 24, 2021

NPPES CertifiedMay 24, 2021

✔ NPI 1366492555 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyObstetrics & GynecologyAllopathic & Osteopathic Physicians

Taxonomy Code207V00000X

License✔ Licensed in IL · 036100496

Definition

An obstetrician/gynecologist possesses special knowledge, skills and professional capability in the medical and surgical care of the female reproductive system and associated disorders. This physician serves as a consultant to other physicians and as a primary physician for women.

1200 S YORK ST STE 2000, Elmhurst, IL 60126

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Accepted Insurance

The full list of accepted plans is on the Insurance tab. Issuers include Ambetter Health, Ambetter Health of Delaware.Insurance ›

Medicare Participation & PECOS CMS

Medicare enrollment, assignment, billing reassignment, and ordering and referring status from CMS.

Medicare Enrollment Status

✔

Enrolled in Medicare and accepts Medicare assignment

Nirali J Ghia Md is registered in PECOS and agrees to accept the Medicare-approved amount as full payment. Medicare patients are not billed beyond the standard deductible and coinsurance.

PECOS PAC ID8325178379

PECOS Enrollment IDI20100617000598

Eligible to Order & Refer✔ Part B Labs & Imaging✔ Durable Medical Equipment✔ Home Health Agency✔ Power Mobility DevicesPer the CMS Ordering and Referring file. Eligibility means Medicare pays claims that this provider orders or refers for these categories.

Medicare Billing Reassignments

Medicare enrollment records show Nirali Ghia reassigns Medicare billing to 2 organizations. Each organization bills Medicare for the services this provider delivers there; the nearest is listed first.

Elmhurst Memorial Healthcare

Same address

Multi-Specialty

1200 S YORK ST
Elmhurst, IL 60126

Reassigned Medicare billing, Illinois enrollment
240 clinicians in this Medicare group

NPI 1457493454 (331) 221-9000

Endeavor Health Medical Group

19 mi

Allergy & Immunology

1000 CENTRAL ST
Evanston, IL 60201

Reassigned Medicare billing, Illinois enrollment
4,841 clinicians in this Medicare group

NPI 1497701882 (847) 570-5235

Source: CMS Revalidation Reassignment List, October 2026 release. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.

Areas of Expertise CMS Part B claims 4

Services this provider delivered to Medicare fee-for-service patients, from the CMS Medicare utilization data. Higher counts generally reflect more experience with a service; care delivered outside Medicare is not included.

Established patient office or other outpatient visit with low level od decision making, if using time, 20 minutes or more 99213

This is a routine visit for patients who have already been seen by the healthcare provider. During this approximately 20-29 minute appointment, your health status will be evaluated and any necessary treatments or tests will be discussed. It's a chance to address any health concerns you may have.

31 services20 patients

Cervical or vaginal cancer screening; pelvic and clinical breast examination G0101

This procedure involves checking for health issues in the lower abdomen and chest area. It helps identify early signs of certain conditions, increasing the chance for successful treatment. It's a routine check-up that's important for maintaining good health.

28 services28 patients

Screening papanicolaou smear; obtaining, preparing and conveyance of cervical or vaginal smear to laboratory Q0091

A Papanicolaou smear, often called a Pap smear, is a test to check for changes in cells. A small sample is gently collected from the lower region and sent to a lab for examination. This helps in early detection of potential health issues.

13 services13 patients

Established patient office or other outpatient visit with moderate level of decision making, if using time, 30 minutes or more 99214

This is a routine check-up for patients who have previously visited our clinic. It involves a comprehensive review of your health and any ongoing treatments. The consultation lasts between 30-39 minutes, allowing enough time to discuss any concerns.

11 services11 patients

Hospital Affiliations CMS Care Compare

Hospitals where this provider delivers care, identified from recent Medicare claims and place-of-service records.

Elmhurst Memorial Hospital

Acute Care Hospitals · Elmhurst, IL

4/5 CMS rating

OwnershipProprietary

CMS Certification Number140200

Location155 East Brush Hill RoadElmhurst, IL 60126 · Du Page County

Emergency services Birthing friendly

Physician Visit Costs CMS claims · ZIP area

Typical Medicare office-visit costs in the 60126 ZIP code area, from fee-for-service claims. These are area statistics, not this provider’s prices; actual charges vary by service and coverage.

New Patient

$137.43 typical visit price

range $59.81 – $181.38

Typical copayment $34.35 (range $14.95 – $45.34)

Most-billed visit code 99204

Established Patient

$74.38 typical visit price

range $19.15 – $147.12

Typical copayment $18.59 (range $4.78 – $36.78)

Most-billed visit code 99213

Amounts reflect what Medicare beneficiaries in this ZIP area are typically charged for office visits. Patients with other coverage should check their individual plans.

Medicare Quality Performance CMS QPP · MIPS

Performance in the CMS Quality Payment Program: the MIPS final score across four weighted categories, and the individual quality measures reported to Medicare.

91.35/100

MIPS Final ScoreMerit-based Incentive Payment System · CMS Quality Payment Program

Scored through an Alternative Payment Model

Quality

82.71

Promoting Interoperability

100

Improvement Activities

Other Providers at the Same Location NPPES 20

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

VICTORIA URIBE MD

Pediatrics