Fred J. Halloran, MD, SC

Primary specialty

Primary Care Clinic/CenterTaxonomy code 261QP2300X

License

036081972 Issued in IL

Legal business name

FRED J. HALLORAN, MD, SC

Practice address

11904 Oak Creek Pkwy
Huntley, IL 60142-6728

Phone

(847) 506-1478

Fax

(224) 858-4001

NPI assigned

Mar 12, 2008

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mr. Fred J. Halloran, M.D.NPI 1568434942

Title

Owner

Phone

(847) 506-1478

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in IL

Enrollment records 1

Locations

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Fred J Halloran, MD

  • Internal Medicine Physician
  • Huntley, IL
  • NPI 1568434942
  Medicare reassignment NPD Authorized official
• Lisa Marie Petrongelli, PSY.D, APRN-BC, FPA

  • Psychiatric/Mental Health Nurse Practitioner
  • Hoffman Estates, IL
  • NPI 1306281332

  Single Specialty

  Medicare reassignment NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1205280000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1705449600000",
    "number": "1295906774",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11904 OAK CREEK PKWY",
            "city": "HUNTLEY",
            "state": "IL",
            "postal_code": "601426728",
            "telephone_number": "847-506-1478",
            "fax_number": "224-858-4001"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11904 OAK CREEK PKWY",
            "city": "HUNTLEY",
            "state": "IL",
            "postal_code": "601426728",
            "telephone_number": "847-506-1478",
            "fax_number": "224-858-4001"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FRED J. HALLORAN, MD, SC",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-03-12",
        "last_updated": "2024-01-17",
        "certification_date": "2024-01-17",
        "status": "A",
        "authorized_official_last_name": "HALLORAN",
        "authorized_official_first_name": "FRED",
        "authorized_official_middle_name": "J.",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "847-506-1478",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "261QP2300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Primary Care",
            "state": "IL",
            "license": "036081972",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "036081972",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Betsy Felde, RD
• Piero Marco Antonio Fisichella, MD, MBA
• Jennifer N Fleming, RD
• Rachelle Puno Flynn, FNP-BC
• Fox Valley Hematology Inc
• Jacob Fulton, PHARMD
• Faith A Furst
• Katrina Gallagher, N.P.
• Brett R Galley, M.D.
• Ana Eloisa Garcia, APRN, CRNA

• Primary Care Clinic/Center in Huntley, IL
• Providers in Huntley, IL by specialty
• Primary Care Clinic/Center in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 17, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.