NICOLE MICHELLE TABATABAI BLYTHE DNP, PMHNP-BC - NPI 1710595111

Q: What is the provider's specialty?

The provider's specialty is Nurse Practitioner with taxonomy code 363LP0808X and a focus in Psychiatric/Mental Health.

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About Nicole Michelle Tabatabai Blythe Dnp, Pmhnp-bc NPPES

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

NICOLE MICHELLE TABATABAI BLYTHE DNP, PMHNP-BC (NPI 1710595111) is an individual psychiatric/mental health provider in Chicago, Illinois, licensed in Illinois (209029818) and active in the NPI registry since July 2020. She is enrolled in Medicare PECOS and is a graduate of Other (2023).

NPPES Registry Identity

NPI1710595111

Entity TypeIndividualFemale

Primary Taxonomy363LP0808X

Provider Legal NameNICOLE MICHELLE TABATABAI BLYTHECredential: DNP, PMHNP-BC

Location Address25 E WASHINGTON ST STE 1601Chicago, IL 60602-1882

Mailing Address25 E Washington St Ste 1601Chicago, IL 60602-1882 · (312) 276-4000 · Fax (312) 276-4000

Phone(312) 450-0313

Fax(312) 276-4000

Sole ProprietorNo

Medical School CMSOtherGraduated 2023

Enumeration DateJuly 21, 2020

Last NPPES UpdateApril 13, 20264 updates tracked since enumeration

NPPES CertifiedApril 13, 2026

✔ NPI 1710595111 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyNurse Practitioner · Psychiatric/Mental HealthPhysician Assistants & Advanced Practice Nursing Providers

Taxonomy Code363LP0808X

License✔ Licensed in IL · 209029818

25 E WASHINGTON ST STE 1601, Chicago, IL 60602

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Accepted Insurance

The full list of accepted plans is on the Insurance tab. Issuers include Providence Health Plan.Insurance ›

Medicare Participation & PECOS CMS

Medicare enrollment, assignment, and ordering and referring status from the CMS PECOS system.

Medicare Enrollment Status

✔

Enrolled in Medicare and accepts Medicare assignment

Nicole Michelle Tabatabai Blythe Dnp, Pmhnp-bc 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 ID3375084825

PECOS Enrollment IDI20240924002137

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.

Physician Visit Costs CMS claims · ZIP area

Typical Medicare office-visit costs in the 60602 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

$94.06 typical visit price

range $60.08 – $183.39

Typical copayment $23.51 (range $15.02 – $45.84)

Most-billed visit code 99203

Established Patient

$105.70 typical visit price

range $18.97 – $148.12

Typical copayment $26.42 (range $4.74 – $37.03)

Most-billed visit code 99214

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

Other Providers at the Same Location NPPES 11

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

MARK GINDI MD SC

Psychiatry & Neurology (Psychiatry)