Active NPI
Robert David Halstead, M.D.
- Pediatrics Physician
- McHenry, IL
National Provider Identifier
1003874827
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pediatrics Physician
- License
- 036348961
- Practice address
- 4309 W Medical Center Dr
Suite B310
McHenry, IL 60050-8419 - Phone
- (815) 344-3900
- Fax
- (815) 759-4666
- NPI assigned
- May 2, 2006
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pediatrics Physician | 208000000X | 036348961 | IL | Primary |
Addresses
Primary practice location
4309 W Medical Center Dr
Suite B310
McHenry, IL 60050-8419
Mailing address
4309 W Medical Center Dr
Ste B310
McHenry, IL 60050
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 036348961 | IL | MD | Pediatrics Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1146528000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1501545600000",
"number": "1003874827",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4309 W MEDICAL CENTER DR",
"address_2": "STE B310",
"city": "MCHENRY",
"state": "IL",
"postal_code": "60050"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4309 W MEDICAL CENTER DR",
"address_2": "SUITE B310",
"city": "MCHENRY",
"state": "IL",
"postal_code": "600508419",
"telephone_number": "815-344-3900",
"fax_number": "815-759-4666"
}
],
"practiceLocations": [],
"basic": {
"last_name": "HALSTEAD",
"first_name": "ROBERT",
"middle_name": "DAVID",
"name_prefix": "Dr.",
"credential": "M.D.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-05-02",
"last_updated": "2017-08-01",
"status": "A"
},
"taxonomies": [
{
"code": "208000000X",
"taxonomy_group": "",
"desc": "Pediatrics",
"state": "IL",
"license": "036348961",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in McHenry, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 1, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.