Active NPI
Jonathan A. Holt, DO
- Internal Medicine Physician
- Highland Park, IL
National Provider Identifier
1720128259
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Internal Medicine Physician
- License
- 036.162121
- Practice address
- 1893 Sheridan Rd
Highland Park, IL 60035-2628 - Phone
- (650) 450-8102
- NPI assigned
- Feb 7, 2007
- Last updated
- Feb 6, 2023
- Sex
- Male
- Sole proprietor
- No
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 |
|---|---|---|---|---|
| Internal Medicine Physician | 207R00000X | 036.162121 | IL | Primary |
Addresses
Primary practice location
1893 Sheridan Rd
Highland Park, IL 60035-2628
Mailing address
2817 W End Ave
436
Nashville, TN 37203-1453
Phone (650) 450-8102
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: Yes
- Opted out of Medicare
- Yes, effective Jan 1, 2023 through Jan 1, 2027
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Osteopathy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 036.162121 | IL | MD | Internal Medicine Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Shifu & Associates | Current | Accepting new patients |
Locations
1893 Sheridan Rd
Ste 301
Highland Park, IL 60035
Phone (650) 450-8102
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1170806400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1675641600000",
"number": "1720128259",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2817 W END AVE",
"address_2": "436",
"city": "NASHVILLE",
"state": "TN",
"postal_code": "372031453",
"telephone_number": "650-450-8102"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1893 SHERIDAN RD",
"city": "HIGHLAND PARK",
"state": "IL",
"postal_code": "600352628",
"telephone_number": "650-450-8102"
}
],
"practiceLocations": [],
"basic": {
"last_name": "HOLT",
"first_name": "JONATHAN",
"middle_name": "A.",
"credential": "DO",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2007-02-07",
"last_updated": "2023-02-06",
"certification_date": "2023-02-06",
"status": "A"
},
"taxonomies": [
{
"code": "207R00000X",
"taxonomy_group": "",
"desc": "Internal Medicine",
"state": "IL",
"license": "036.162121",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}
Other providers in Highland Park, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 6, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring; Opt Out Affidavits.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.