Active NPI
Nathaniel Hollis
- Peer Specialist
- Cleveland, OH
National Provider Identifier
1174163331
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Peer Specialist
- License
- 01519
- Practice address
- 9424 Nelson Ave
Cleveland, OH 44105-4059 - Phone
- (216) 562-9767
- NPI assigned
- Jan 15, 2020
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Addiction (Substance Use Disorder) Counselor | 101YA0400X | |||
| Peer Specialist | 175T00000X | 01519 | OH | Primary |
Addresses
Primary practice location
9424 Nelson Ave
Cleveland, OH 44105-4059
Mailing address
1400 E 55TH St
Cleveland, OH 44103-1304
Phone (216) 848-5428
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)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 01519 | OH | MD | Peer Specialist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1579046400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1607385600000",
"number": "1174163331",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1400 E 55TH ST",
"city": "CLEVELAND",
"state": "OH",
"postal_code": "441031304",
"telephone_number": "216-848-5428"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "9424 NELSON AVE",
"city": "CLEVELAND",
"state": "OH",
"postal_code": "441054059",
"telephone_number": "216-562-9767"
}
],
"practiceLocations": [],
"basic": {
"last_name": "HOLLIS",
"first_name": "NATHANIEL",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2020-01-15",
"last_updated": "2020-12-08",
"certification_date": "2020-12-08",
"status": "A"
},
"taxonomies": [
{
"code": "101YA0400X",
"taxonomy_group": "",
"desc": "Counselor, Addiction (Substance Use Disorder)",
"state": null,
"license": null,
"primary": false
},
{
"code": "175T00000X",
"taxonomy_group": "",
"desc": "Peer Specialist",
"state": "OH",
"license": "01519",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Cleveland, OH
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 8, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.