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NICHOLAS RYAN MATHENIA D.O.
NPI 1720377328
Psychiatry & Neurology - Neurology in Naperville, IL

Active since April 04, 2011PECOS EnrolledAccepts Medicare Assignment
91.35/100
CMS Quality Rating
120 SPALDING DR, SUITE 101, NAPERVILLE, IL 60540(630) 527-7730 Get Directions Write a Review

NPPES record last updated: January 26, 2021. Verified against the NPPES registry weekly; last sync: August 09, 2026.

Record update history: Jan 26, 2021, Sep 2, 2016, Jan 13, 2016 (3 updates tracked since 2016).

About Nicholas Ryan Mathenia D.o. NPPES

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

NICHOLAS RYAN MATHENIA D.O. (NPI 1720377328) is an individual neurology provider in Naperville, Illinois, licensed in Illinois (336096512) and active in the NPI registry since April 2011. He is enrolled in Medicare PECOS, is affiliated with Elmhurst Memorial Hospital, and is a graduate of Midwestern University, Chicago College Of Osteopathic Med (2011).

NPPES Registry Identity

NPI1720377328
Entity TypeIndividualMale
Primary Taxonomy2084N0400X
Provider Legal NameNICHOLAS RYAN MATHENIACredential: D.O.
Location Address120 SPALDING DR, SUITE 101Naperville, IL 60540-6508
Mailing Address120 Spalding Dr, Suite 101Naperville, IL 60540-6508 · (630) 527-7730
Phone(630) 527-7730
Sole ProprietorYes
Medical School CMSMidwestern University, Chicago College Of Osteopathic MedGraduated 2011
Enumeration DateApril 4, 2011
Last NPPES UpdateJanuary 26, 20213 updates tracked since enumeration
NPPES CertifiedJanuary 26, 2021
✔ NPI 1720377328 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 2

★ Primary SpecialtyPsychiatry & Neurology · NeurologyAllopathic & Osteopathic Physicians
Taxonomy Code2084N0400X
License✔ Licensed in IL · 336096512
Definition
A Neurologist specializes in the diagnosis and treatment of diseases or impaired function of the brain, spinal cord, peripheral nerves, muscles, autonomic nervous system, and blood vessels that relate to these structures.
Also ListedStudent in an Organized Health Care Education/Training ProgramTaxonomy 390200000X
120 SPALDING DR, Naperville, IL 60540
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Accepted Insurance

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

Nicholas Ryan Mathenia D.o. 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 ID840593463
PECOS Enrollment IDI20160930000288
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.

Areas of Expertise CMS Part B claims 10

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.
453 services307 patients
New patient office or other outpatient visit with moderate level of medical decision making, if using time, 45 minutes or more 99204
This is a first-time office or outpatient visit lasting between 45-59 minutes. The healthcare provider evaluates your health, discusses your medical history, and may suggest further tests or treatments. It's an opportunity to ask questions and understand your health better.
121 services121 patients
Needle measurement of electrical activity in arm or leg muscles, complete study 95886
This procedure, known as an electromyography (EMG), involves inserting a small needle into your arm or leg muscles to measure their electrical activity. This complete study helps diagnose issues with nerves or muscles, providing valuable data for your treatment plan.
47 services28 patients
Measurement of brain wave activity (eeg), awake and asleep 95819
The measurement of brain wave activity, known as an EEG, records the brain's electrical signals. It's performed when you're awake and asleep to monitor your brain's functioning. It helps in diagnosing conditions like epilepsy, sleep disorders, and other neurological issues.
36 services35 patients
Needle measurement of electrical activity in arm or leg muscles, complete study 95886
This procedure, known as an electromyography (EMG), involves inserting a small needle into your arm or leg muscles to measure their electrical activity. This complete study helps diagnose issues with nerves or muscles, providing valuable data for your treatment plan.
32 services20 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.
32 services32 patients

Hospital Affiliations CMS Care Compare 2

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

Edward Hospital

Acute Care Hospitals · Naperville, IL
5/5 CMS rating
OwnershipVoluntary non-profit - Private
CMS Certification Number140231
Location801 South WashingtonNaperville, IL 60540 · Du Page County
Emergency services Birthing friendly

Physician Visit Costs CMS claims · ZIP area

Typical Medicare office-visit costs in the 60540 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
$105.07 typical visit price
range $19.15 – $147.12
Typical copayment $26.26 (range $4.78 – $36.78)
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.

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
Quality82.71
Promoting Interoperability100
Improvement Activities40

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.

JAMES R DAVIS MD
Specialist
120 SPALDING DR, SUITE 307
NAPERVILLE, IL 60540
Dupage County (630) 355-1102
SHEILA TREFTZ APN
Nurse Practitioner (Acute Care)
120 SPALDING DR, SUITE 401
NAPERVILLE, IL 60540
Dupage County (630) 416-4501
JOSEPH KASH MD
Internal Medicine (Hematology & Oncology)
120 SPALDING DR, SUITE 111
NAPERVILLE, IL 60540
Dupage County (630) 527-3788
MRS. WENDY ANN PAWELSKI LCPC,CADC
Counselor (Professional)
120 SPALDING DR, MOB II SUITE 408
NAPERVILLE, IL 60540
Dupage County (630) 527-5484
EDWARD HEALTH VENTURES
Psychiatry & Neurology (Neurology)
120 SPALDING DR, STE 207
NAPERVILLE, IL 60540
Dupage County (630) 527-7730
KRISTIN R. WATKINS APN-CNP
Nurse Practitioner
120 SPALDING DR
NAPERVILLE, IL 60540
Dupage County (630) 369-7700
JAMES W WIELGOLEWSKI MD
Surgery
120 SPALDING DR, SUITE 100
NAPERVILLE, IL 60540
Dupage County (630) 961-0423
HASSAN PERVEZ M.D.
Internal Medicine (Hematology & Oncology)
120 SPALDING DR, SUITE 111
NAPERVILLE, IL 60540
Dupage County (630) 527-3788

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Nicholas Mathenia's NPI number?

The NPI number for Nicholas Mathenia is 1720377328. It was assigned to this individual provider in the NPPES registry on April 4, 2011.

Where is Nicholas Mathenia located?

Nicholas Mathenia practices at 120 Spalding Dr Suite 101, Naperville, IL 60540. The listed phone number is (630) 527-7730.

What is Nicholas Mathenia's specialty?

The primary specialty registered for this NPI is Psychiatry & Neurology, specializing in Neurology, with taxonomy code 2084N0400X.

Is Nicholas Mathenia enrolled in Medicare?

Yes. Nicholas Mathenia is registered in the Medicare PECOS system and accepts Medicare assignment, which means accepting the Medicare-approved amount as payment in full for covered services.

What insurance does Nicholas Mathenia accept?

Health plans from Ambetter Health, Ambetter Health of Delaware and Ambetter from Home State Health list Nicholas Mathenia as in-network in at least one marketplace plan. Coverage varies by plan and year; verify with the insurer or the provider before a visit.

Is Nicholas Mathenia affiliated with any hospitals?

According to CMS data, Nicholas Mathenia is affiliated with Elmhurst Memorial Hospital and Edward Hospital.

When was this NPI record last updated?

The NPPES record for Nicholas Mathenia was last updated on January 26, 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.