Jasmine Alexandria Holloway

Primary specialty

Physician AssistantTaxonomy code 363A00000X

Practice address

1731 E 120TH St
Los Angeles, CA 90059-3051

Phone

(323) 563-4800

NPI assigned

Jan 20, 2023

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in CA

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

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.

• Shiloh Medical Center Inc

  • Family Medicine Physician
  • Victorville, CA
  • NPI 1245333830
  Medicare reassignment

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1674172800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1674172800000",
    "number": "1023723384",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1731 E 120TH ST",
            "address_2": "ATTN: PA PROGRAM CHARLES DREW UNIVERSITY",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "90059",
            "telephone_number": "323-563-4800"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1731 E 120TH ST",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900593051",
            "telephone_number": "323-563-4800"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HOLLOWAY",
        "first_name": "JASMINE",
        "middle_name": "ALEXANDRIA",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2023-01-20",
        "last_updated": "2023-01-20",
        "certification_date": "2023-01-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Thurston Sonrea Hollis II
• Zachary L Hollis, AMFT
• Anisa Brianna Holloman, MD
• Lisa Carol Holloman, PHARM.D., BCPP
• Dewayna L. Holloway, MFT I
• Marissa Faith Holloway, MAT, ATC
• Robert Patrick Holloway, M.D.
• Alissa Juanita Holly
• Ashley Holly
• Dianne Linda Holly, MS, CCC-SLP

• Physician Assistant in Los Angeles, CA
• Providers in Los Angeles, CA by specialty
• Physician Assistant in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 20, 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.