Active NPI
Nathaniel Overton Holloway III, M.D.
- Therapeutic Radiology Physician
- Chicago, IL
National Provider Identifier
1982659561
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Therapeutic Radiology Physician
- License
- 036073542
- Practice address
- 7531 S Stony Island Ave
Basement
Chicago, IL 60649-3954 - Phone
- (773) 947-7850
- Fax
- (773) 947-7852
- NPI assigned
- May 23, 2006
- 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 |
|---|---|---|---|---|
| Therapeutic Radiology Physician | 2085R0203X | 036073542 | IL | Primary |
Addresses
Primary practice location
7531 S Stony Island Ave
Basement
Chicago, IL 60649-3954
Mailing address
3400 N Lake Shore Dr
Unit 9-B
Chicago, IL 60657-2827
Phone (773) 947-7850
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 036073542 | Medicaid | IL |
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)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 036073542 | IL | MD | Therapeutic Radiology Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Cook County Radiation Oncology,SC | Therapeutic Radiology | Past | Accepting new patients |
| Innovative Outpatient Medical Systems Inc. | Past | Accepting new patients |
Organizations & group practices 2
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.
-
- Therapeutic Radiology Physician
- Chicago, IL
- NPI 1518109552
-
- Comprehensive Outpatient Rehabilitation Facility (CORF)
- Tinley Park, IL
- NPI 1699773911
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1148342400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1248048000000",
"number": "1982659561",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3400 N LAKE SHORE DR",
"address_2": "UNIT 9-B",
"city": "CHICAGO",
"state": "IL",
"postal_code": "606572827",
"telephone_number": "773-947-7850",
"fax_number": "773-947-7852"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "7531 S STONY ISLAND AVE",
"address_2": "BASEMENT",
"city": "CHICAGO",
"state": "IL",
"postal_code": "606493954",
"telephone_number": "773-947-7850",
"fax_number": "773-947-7852"
}
],
"practiceLocations": [],
"basic": {
"last_name": "HOLLOWAY",
"first_name": "NATHANIEL",
"middle_name": "OVERTON",
"name_suffix": "III",
"credential": "M.D.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-05-23",
"last_updated": "2009-07-20",
"status": "A"
},
"taxonomies": [
{
"code": "2085R0203X",
"taxonomy_group": "",
"desc": "Radiology, Therapeutic Radiology",
"state": "IL",
"license": "036073542",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "036073542",
"state": "IL"
}
],
"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 Jul 20, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.