Active NPI
Adam Randolph Travis, M.D.
- Diagnostic Radiology Physician
- Chicago, IL
National Provider Identifier
1336300623
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Diagnostic Radiology Physician
- License
- 036127714
- Practice address
- 565 W Quincy St Unit 1613
Chicago, IL 60661-2912 - Phone
- (502) 338-3580
- NPI assigned
- Jun 19, 2008
- 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 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Diagnostic Radiology Physician | 2085R0202X | 036127714 | IL | Primary |
Addresses
Primary practice location
565 W Quincy St Unit 1613
Chicago, IL 60661-2912
Mailing address
565 W Quincy St Unit 1613
Chicago, IL 60661-2912
Phone (502) 338-3580
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
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 036127714 | IL | MD | Diagnostic Radiology Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1213833600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1367798400000",
"number": "1336300623",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "565 W QUINCY ST UNIT 1613",
"city": "CHICAGO",
"state": "IL",
"postal_code": "606612912",
"telephone_number": "502-338-3580"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "565 W QUINCY ST UNIT 1613",
"city": "CHICAGO",
"state": "IL",
"postal_code": "606612912",
"telephone_number": "502-338-3580"
}
],
"practiceLocations": [],
"basic": {
"last_name": "TRAVIS",
"first_name": "ADAM",
"middle_name": "RANDOLPH",
"name_prefix": "Dr.",
"credential": "M.D.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2008-06-19",
"last_updated": "2013-05-06",
"status": "A"
},
"taxonomies": [
{
"code": "2085R0202X",
"taxonomy_group": "",
"desc": "Radiology, Diagnostic Radiology",
"state": "IL",
"license": "036127714",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Chicago, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 6, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.