NPIMap

Individual provider Active NPI

Justin Philip Hollm, M.D.

  • Emergency Medicine Physician
  • Columbia, SC
National Provider Identifier
1053761452
Registry record updated Jun 16, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Emergency Medicine PhysicianTaxonomy code 207P00000X
License
LL39685 Issued in SC
Practice address
14 Medical Park Ste 350
Emergency Medicine Department
Columbia, SC 29203
Phone
(803) 434-3790
Fax
(803) 434-3946
NPI assigned
Jun 16, 2016
Last updated
Jun 16, 2016By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 16, 2016

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Emergency Medicine Physician 207P00000X LL39685 SC Primary

Addresses

Primary practice location

14 Medical Park Ste 350
Emergency Medicine Department
Columbia, SC 29203

Mailing address

14 Medical Park Ste 350
Emergency Medicine Department
Columbia, SC 29203
Phone (803) 434-3790

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in SC
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
I20181207000810 SC Practitioner - Emergency Medicine 5092059618 Reassigns benefits to 7 organizations

Care Compare profile

Medicare Care Compare
Specialty
Emergency Medicine
Education
Other, 2016
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Self Medical GroupGroup PAC ID 6002953916, 393 clinicians
Ich ER Services LLCGroup PAC ID 2860744331, 30 clinicians

Practice addresses (Care Compare)

1325 Spring St
Greenwood, SC 29646-3860
Phone (864) 725-4398

420 Thomson Cir
Abbeville, SC 29620-5656
Phone (864) 366-1649

800 N Fant St
Anderson, SC 29621-5708
Phone (864) 512-1000

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Removal of nail tissue1-10

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
LL39685SCMDEmergency Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
McLeod Health Cheraw CurrentSince Sep 16, 2018 Accepting new patients
Abbeville County Memorial Hospital CurrentSince Sep 5, 2024 Accepting new patients
Greenwood County Current Accepting new patients
Self Regional Healthcare Partners CurrentSince Jan 1, 2026 Accepting new patients
Ich ER Services, LLC Emergency Medicine CurrentSince Aug 1, 2025 Accepting new patients
McLeod Health Cheraw Emergency Medicine CurrentSince Sep 16, 2018 Accepting new patients
Self Medical Group CurrentSince Dec 3, 2018 Accepting new patients
Abbeville County Memorial Hospital CurrentSince Sep 5, 2024 Accepting new patients
Self Medical Group CurrentSince Dec 3, 2018 Accepting new patients
Self Regional Healthcare Partners Emergency Medicine CurrentSince Jan 1, 2026 Accepting new patients
Greenwood County EMS Current Accepting new patients
Self Medical Group Current Accepting new patients
Self Regional Healthcare Past Accepting new patients

Locations

75 Remittance Dr
Dept 6764
Chicago, IL 60675

420 Thomson Cir
Abbeville, SC 29620
Phone (864) 366-1649

800 N Fant St
Anderson, SC 29621
Phone (864) 512-1000

711 Chesterfield Hwy
Cheraw, SC 29520
Phone (843) 320-3304

300 Ridge Medical Plaza Rd
Edgefield, SC 29824
Phone (803) 637-3174

1325 Spring St
Greenwood, SC 29646
Phone (864) 227-4111

2605 Kinard St
Ste 200
Newberry, SC 29108
Phone (803) 276-1866

Interoperability endpoints

  • Direct secure messaging: jhollm247694@selfregional.direct-ci.net
  • Direct secure messaging: jhollm86670@direct.anmedhealth.net

Organizations & group practices 13

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.

View all 13

Hospital & facility affiliations 6

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": "1466035200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1466035200000",
    "number": "1053761452",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "14 MEDICAL PARK STE 350",
            "address_2": "EMERGENCY MEDICINE DEPARTMENT",
            "city": "COLUMBIA",
            "state": "SC",
            "postal_code": "29203",
            "telephone_number": "803-434-3790",
            "fax_number": "803-434-3946"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "14 MEDICAL PARK STE 350",
            "address_2": "EMERGENCY MEDICINE DEPARTMENT",
            "city": "COLUMBIA",
            "state": "SC",
            "postal_code": "29203",
            "telephone_number": "803-434-3790",
            "fax_number": "803-434-3946"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HOLLM",
        "first_name": "JUSTIN",
        "middle_name": "PHILIP",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2016-06-16",
        "last_updated": "2016-06-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "SC",
            "license": "LL39685",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Columbia, SC

Sources for this page

Verify at the official NPI Registry.