Individual provider Active NPI

Holley R Harris, APN

  • Nurse Practitioner
  • Geneva, IL
National Provider Identifier
1437586583
Registry record updated Sep 12, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nurse PractitionerTaxonomy code 363L00000X
License
209.010766 Issued in IL
Practice address
351 Delnor Dr
Geneva, IL 60134-4220
Phone
(630) 232-0280
Fax
(630) 232-3895
NPI assigned
Oct 3, 2013
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 12, 2018

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X 209010766 IL
Nurse Practitioner 363L00000X 209.010766 IL Primary

Addresses

Primary practice location

351 Delnor Dr
Geneva, IL 60134-4220

Mailing address

25 N Winfield Rd
Winfield, IL 60190-1295
Phone (630) 232-0280

Other practice location 1

2088 Ogden Ave
Suite 140
Aurora, IL 60504-4376
Phone (630) 851-6400

Other practice location 2

25 N Winfield Rd
Winfield, IL 60190-1295
Phone (630) 232-0280

Other identifiers 2

IdentifierTypeStateIssuer
206147OtherILMEDICARE GROUP PTAN
F400439285OtherILMEDICARE INDIVIDUAL PTAN

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IL
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20170420002357 IL Practitioner - Nurse Practitioner 1951538396 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
University of Illinois College of Med (CHI/Peor/Rock/CHM-Urb), 2013
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
University of ChicagoGroup PAC ID 7719899426, 1,674 clinicians

Practice addresses (Care Compare)

5841 S Maryland Ave
Chicago, IL 60637-1443
Phone (888) 824-0200

Hospital & facility affiliations

  • The University of Chicago Medical Center Hospital, Chicago, IL, CCN 140088

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
209.010766ILMDNurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
The University of Chicago Medical Center CurrentSince May 14, 2021 Accepting new patients
The University of Chicago Medical Center CurrentSince May 14, 2021 Accepting new patients
University of Chicago CurrentSince May 14, 2021 Accepting new patients
Fox Valley Cardiovascular Consultants, LLC Past Accepting new patients

Locations

150 Harvester Dr
Ste 300
Burr Ridge, IL 60527
Phone (773) 702-1061

350 N Wall St
Kankakee, IL 60901
Phone (815) 935-7500

120 N Oak St
Oak Brook Mall, IL 60521
Phone (630) 856-6700

Interoperability endpoints

  • Direct secure messaging: hharris205252@uchospital.direct-ci.com

Organizations & group practices 4

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

Hospital & facility affiliations 1

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1380758400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1536710400000",
    "number": "1437586583",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "25 N WINFIELD RD",
            "city": "WINFIELD",
            "state": "IL",
            "postal_code": "601901295",
            "telephone_number": "630-232-0280",
            "fax_number": "630-232-3895"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "351 DELNOR DR",
            "city": "GENEVA",
            "state": "IL",
            "postal_code": "601344220",
            "telephone_number": "630-232-0280",
            "fax_number": "630-232-3895"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2088 Ogden Ave",
            "address_2": "Suite 140",
            "address_purpose": "LOCATION",
            "city": "Aurora",
            "state": "IL",
            "postal_code": "605044376",
            "country_code": "US",
            "telephone_number": "630-851-6400",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "25 N Winfield Rd",
            "address_purpose": "LOCATION",
            "city": "Winfield",
            "state": "IL",
            "postal_code": "601901295",
            "country_code": "US",
            "telephone_number": "630-232-0280",
            "fax_number": "630-232-3895",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "HARRIS",
        "first_name": "HOLLEY",
        "middle_name": "R",
        "credential": "APN",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2013-10-03",
        "last_updated": "2018-09-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "IL",
            "license": "209010766",
            "primary": false
        },
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "IL",
            "license": "209.010766",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE GROUP PTAN",
            "identifier": "206147",
            "state": "IL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE INDIVIDUAL PTAN",
            "identifier": "F400439285",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Geneva, IL

Sources for this page

Verify at the official NPI Registry.