NPIMap

Individual provider Active NPI

Kelley D Holland, PA

  • Medical Physician Assistant
  • Lake City, FL
National Provider Identifier
1023787074
Registry record updated Apr 11, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Medical Physician AssistantTaxonomy code 363AM0700X
License
PAT9114916 Issued in FL
Practice address
340 NW Commerce Dr
Lake City, FL 32055-4709
Phone
(386) 719-9000
NPI assigned
Sep 12, 2021
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 11, 2022

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Medical Physician Assistant 363AM0700X PAT9114916 FL Primary

Addresses

Primary practice location

340 NW Commerce Dr
Lake City, FL 32055-4709

Mailing address

4240 Liron Ave Apt 103
Fort Myers, FL 33916-7868
Phone (302) 419-6173

Other practice location 1

1600 SW Archer Rd
Gainesville, FL 32610-3003
Phone (352) 265-5555

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
I20211109002764 FL Practitioner - Physician Assistant 7012306228 Reassigns benefits to 4 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2021
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

1600 SW Archer
Gainesville, FL 32610-3003

1600 SW Archer Rd
Gainesville, FL 32610-3003

1600 SW Archer Rd RM
1191 Uf Health Surgical Specialists Shands
Gainesville, FL 32610-3003
Phone (352) 265-0535

2000 SW Archer Rd
Uf Health Congenital Heart Center Medical P
Gainesville, FL 32610-3003
Phone (352) 265-8250

2001 SW 13TH St
Gainesville, FL 32608-1532
Phone (352) 265-8990

Uf Health Test Site Pop Up 1600 SW Ar
Gainesville, FL 32610-3003
Phone (352) 392-1161

Hospital & facility affiliations

  • Uf Health Shands Hospital Hospital, Gainesville, FL, CCN 100113

Merit-based Incentive Payment System (MIPS)

Final score
47.54 of 100Reported as apm
Quality
38.49
Promoting interoperability
0
Improvement activities
40

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

State licenses

LicenseStateTypeSpecialty
PAT9114916FLMDMedical Physician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
FL-I Medical Services LLC CurrentSince Oct 20, 2021 Accepting new patients
Tampa General Hospital Current Accepting new patients
Florida Clinical Practice Association Inc CurrentSince Apr 19, 2022 Accepting new patients
FL-I Medical Services LLC CurrentSince Oct 20, 2021 Accepting new patients
Florida Clinical Practice Association Inc CurrentSince Apr 19, 2022 Accepting new patients

Locations

322 SW Pine Island Rd
Cape Coral, FL 33991
Phone (941) 249-6858

996 Airport Rd
Destin, FL 32541
Phone (615) 338-1250

2001 SW 13th St
Gainesville, FL 32608
Phone (352) 265-8990

1600 SW Archer Rd
Gainesville, FL 32610
Phone (352) 265-0077

340 NW Commerce Dr
Lake City, FL 32055
Phone (386) 719-9000

20900 Biscayne Blvd
Miami, FL 33180
Phone (305) 682-7290

Networks

  • Freedom Health HMO Network
  • Optimum HealthCare HMO Network

Interoperability endpoints

  • Direct secure messaging: kholland576519@direct.shands.ufl.edu
  • Direct secure messaging: kholland296373@direct.tgh.org
  • FHIR API: https://epicproxy.et0761.epichosted.com/FHIRProxy/api/FHIR/R4/

Organizations & group practices 8

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.

Hospital & facility affiliations 8

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": "1631404800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1649635200000",
    "number": "1023787074",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4240 LIRON AVE APT 103",
            "city": "FORT MYERS",
            "state": "FL",
            "postal_code": "339167868",
            "telephone_number": "302-419-6173"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "340 NW COMMERCE DR",
            "city": "LAKE CITY",
            "state": "FL",
            "postal_code": "320554709",
            "telephone_number": "386-719-9000"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1600 SW Archer Rd",
            "address_purpose": "LOCATION",
            "city": "Gainesville",
            "state": "FL",
            "postal_code": "326103003",
            "country_code": "US",
            "telephone_number": "352-265-5555",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "HOLLAND",
        "first_name": "KELLEY",
        "middle_name": "D",
        "credential": "PA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2021-09-12",
        "last_updated": "2022-04-11",
        "certification_date": "2022-04-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "FL",
            "license": "PAT9114916",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Lake City, FL

Sources for this page

Verify at the official NPI Registry.