NPIMap

Individual provider Active NPI

Nathan Fedors, M.D.

  • Diagnostic Radiology Physician
  • Maywood, IL
National Provider Identifier
1699933366
Registry record updated May 30, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Diagnostic Radiology PhysicianTaxonomy code 2085R0202X
License
036128494 Issued in IL
Practice address
2160 S 1St Ave
Loyola University Medical Center, Dept. of Radiology
Maywood, IL 60153-3328
Phone
(708) 216-1084
NPI assigned
May 29, 2008
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on May 30, 2012

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Diagnostic Radiology Physician 2085R0202X 036128494 IL Primary

Addresses

Primary practice location

2160 S 1St Ave
Loyola University Medical Center, Dept. of Radiology
Maywood, IL 60153-3328

Mailing address

2160 S 1St Ave
Loyola University Medical Center, Dept. of Radiology
Maywood, IL 60153-3328
Phone (708) 216-1084

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NC, NY2 enrollments
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20120905000359 NC Practitioner - Diagnostic Radiology 3577710078 Reassigns benefits to 2 organizations
I20130820001016 NY Practitioner - Diagnostic Radiology 3577710078 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Diagnostic Radiology
Education
Other, 2007
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Wake Forest Baptist Imaging LLCGroup PAC ID 3173681681, 76 clinicians

Practice addresses (Care Compare)

265 Executive Park Blvd
Winston Salem, NC 27103-1503
Phone (336) 765-5722

Medical Ctr Blvd
Winston Salem, NC 27157-0001
Phone (336) 716-2734

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
036128494ILMDDiagnostic Radiology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Wake Forest University Health Sciences CurrentSince Aug 1, 2022 Accepting new patients
Wake Forest Baptist Imaging, LLC Diagnostic Radiology CurrentSince Aug 1, 2022 Accepting new patients
Wake Forest Baptist Imaging LLC Diagnostic Radiology CurrentSince Sep 27, 2024 Accepting new patients
Syracuse Orthopedic Specialists, PLLC CurrentSince Jul 15, 2013 Accepting new patients
Medical Imaging Center LLP CurrentSince Jul 1, 2013 Accepting new patients
Wake Forest Baptist Imaging, LLC Diagnostic Radiology CurrentSince Aug 1, 2022 Accepting new patients

Locations

861 Old Winston Rd
Ste 105
Kernersville, NC 27284
Phone (336) 765-5722

100 Kimel Forest Dr
Winston Salem, NC 27103
Phone (336) 713-0947

265 Executive Park Blvd
Winston Salem, NC 27103
Phone (336) 765-5722

Medical Ctr Blvd
Winston Salem, NC 27157
Phone (336) 713-2697

37 W Garden St
Ste 107
Auburn, NY 13021
Phone (315) 255-2828

5700 W Genesee St
Ste 7
Camillus, NY 13031
Phone (315) 701-1670

5008 Brittonfield Pkwy
East Syracuse, NY 13057
Phone (315) 634-5056

5000 Brittonfield Pkwy
Ste A114
East Syracuse, NY 13057
Phone (315) 472-4701

4900 Broad Rd
Syracuse, NY 13215
Phone (315) 492-5011

736 Irving Ave
Syracuse, NY 13210
Phone (315) 470-7111

725 Irving Ave
Ste 209
Syracuse, NY 13210
Phone (315) 472-4364

5719 Widewaters Pkwy
Syracuse, NY 13214
Phone (315) 251-3110

Interoperability endpoints

  • Direct secure messaging: nfedors2754557@carolinashealthcaresystem.direct-ci.com

Organizations & group practices 6

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 10

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": "1212019200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1338336000000",
    "number": "1699933366",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2160 S 1ST AVE",
            "address_2": "LOYOLA UNIVERSITY MEDICAL CENTER, DEPT. OF RADIOLOGY",
            "city": "MAYWOOD",
            "state": "IL",
            "postal_code": "601533328",
            "telephone_number": "708-216-1084"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2160 S 1ST AVE",
            "address_2": "LOYOLA UNIVERSITY MEDICAL CENTER, DEPT. OF RADIOLOGY",
            "city": "MAYWOOD",
            "state": "IL",
            "postal_code": "601533328",
            "telephone_number": "708-216-1084"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FEDORS",
        "first_name": "NATHAN",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2008-05-29",
        "last_updated": "2012-05-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2085R0202X",
            "taxonomy_group": "",
            "desc": "Radiology, Diagnostic Radiology",
            "state": "IL",
            "license": "036128494",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Maywood, IL

Sources for this page

Verify at the official NPI Registry.