Active NPI
Jeremy Hollingsworth
- Home Modifications Contractor
- Lakeville, MN
National Provider Identifier
1013864362
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Home Modifications Contractor
- License
- QB691092
- Practice address
- 8200 190TH St W
Lakeville, MN 55044-7858 - Phone
- (952) 210-4881
- NPI assigned
- Mar 16, 2026
- 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 |
|---|---|---|---|---|
| Home Modifications Contractor | 171WH0202X | QB691092 | MN | Primary |
Addresses
Primary practice location
8200 190TH St W
Lakeville, MN 55044-7858
Mailing address
8200 190TH St W
Lakeville, MN 55044-7858
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)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| QB691092 | MN | MD | Home Modifications Contractor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1773619200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1773619200000",
"number": "1013864362",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "8200 190TH ST W",
"city": "LAKEVILLE",
"state": "MN",
"postal_code": "550447858"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "8200 190TH ST W",
"city": "LAKEVILLE",
"state": "MN",
"postal_code": "550447858",
"telephone_number": "952-210-4881"
}
],
"practiceLocations": [],
"basic": {
"last_name": "HOLLINGSWORTH",
"first_name": "JEREMY",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2026-03-16",
"last_updated": "2026-03-16",
"certification_date": "2026-03-15",
"status": "A"
},
"taxonomies": [
{
"code": "171WH0202X",
"taxonomy_group": "",
"desc": "Contractor, Home Modifications",
"state": "MN",
"license": "QB691092",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Lakeville, MN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 16, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.