NPIMap

Individual provider Active NPI

Kevin Holthaus, MD

  • Specialist
  • Jacksonville Beach, FL
National Provider Identifier
1003893215
Registry record updated Nov 21, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
SpecialistTaxonomy code 174400000X
License
ME43785 Issued in FL
Practice address
1361 13TH Ave S
Ste 150
Jacksonville Beach, FL 32250-3233
Phone
(904) 242-7177
Fax
(904) 242-7133
NPI assigned
Dec 29, 2005
Last updated
Nov 21, 2007By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 21, 2007

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Specialist 174400000X ME43785 FL Primary

Addresses

Primary practice location

1361 13TH Ave S
Ste 150
Jacksonville Beach, FL 32250-3233

Mailing address

PO Box 17809
Jacksonville, FL 32245-7809
Phone (904) 723-0015

Other identifiers 2

IdentifierTypeStateIssuer
110241847OtherFLRAILROAD MEDICARE
15832OtherFLBCBS

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20050917000269 FL Practitioner - Internal Medicine 2860425147 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Internal Medicine
Education
Michigan State University College of Human Medicine, 1982
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
North Florida Medical Clinic IncGroup PAC ID 7315970688, 2 clinicians

Practice addresses (Care Compare)

1361 13TH Ave S
Suite 150
Jacksonville Beach, FL 32250-3235
Phone (904) 242-7177

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Removal of tissue1-10
Removal of skin lesions1-10

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
North Florida Medical Clinic Inc CurrentSince Jun 30, 2005 Accepting new patients
Baptist Cardiology, Inc. PastSince Aug 1, 2009 Accepting new patients

Locations

1361 13th Ave S
Ste 150
Jax Bch, FL 32250
Phone (904) 242-7177

Interoperability endpoints

  • Direct secure messaging: kevin.holthaus.1@32807.direct.athenahealth.com

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 7

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": "1135814400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1195603200000",
    "number": "1003893215",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 17809",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322457809",
            "telephone_number": "904-723-0015",
            "fax_number": "904-338-0951"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1361 13TH AVE S",
            "address_2": "STE 150",
            "city": "JACKSONVILLE BEACH",
            "state": "FL",
            "postal_code": "322503233",
            "telephone_number": "904-242-7177",
            "fax_number": "904-242-7133"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HOLTHAUS",
        "first_name": "KEVIN",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-12-29",
        "last_updated": "2007-11-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "",
            "desc": "Specialist",
            "state": "FL",
            "license": "ME43785",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "110241847",
            "state": "FL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "15832",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Jacksonville Beach, FL

Sources for this page

Verify at the official NPI Registry.