Individual provider Active NPI

Holly Ann Gates, NP

  • Nurse Practitioner
  • Benton, IL
National Provider Identifier
1063991206
Registry record updated Feb 4, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nurse PractitionerTaxonomy code 363L00000X
License
277001378 Issued in IL
Practice address
203 Bailey LN Ste 1
Benton, IL 62812-2266
Phone
(618) 438-5670
Fax
(618) 438-5709
NPI assigned
Aug 8, 2018
Last updated
Feb 4, 2026By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 4, 2026

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Nurse Practitioner 363L00000X 277001378 IL Primary

Addresses

Primary practice location

203 Bailey LN Ste 1
Benton, IL 62812-2266

Mailing address

PO Box 3988
Carbondale, IL 62902-3988
Phone (618) 457-5200

Other practice location 1

2601 W Main St
Carbondale, IL 62901-1031
Phone (618) 549-5361

Other practice location 2

405 Rushing Dr
Herrin, IL 62948-3730
Phone (618) 993-3300

Other practice location 3

117 E Clark St
Harrisburg, IL 62946-2702
Phone (618) 252-8625

Other practice location 4

502 W Saint Louis St Ste 4
West Frankfort, IL 62896-1968
Phone (618) 937-3400

Other names 1

  • Mrs. Holly Ryder Former name

Electronic endpoints 5

TypeEndpointUseAffiliation
Direct Messaging Address hgates86235@sih.direct-ci.com
Direct Messaging Address hgates86235@sih.direct-ci.com
Direct Messaging Address hgates86235@sih.direct-ci.com
Direct Messaging Address hgates86235@sih.direct-ci.com
Direct Messaging Address hgates86235@sih.direct-ci.com

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IL
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

Enrollment IDStateProvider typePAC IDDetails
I20190626003031 IL Practitioner - Nurse Practitioner 7618201500 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2018
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

203 Bailey LN
Suite 1
Benton, IL 62812-1969
Phone (618) 438-5670

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Shawnee Health Service and Development Corp Current Accepting new patients
Shawnee Health Service and Development Corp CurrentSince Aug 19, 2019 Accepting new patients
Shawnee Health Service and Development Corp CurrentSince Aug 19, 2019 Accepting new patients
Southern Illinois Medical Services, NFP CurrentSince Jan 26, 2026 Accepting new patients
Shawnee Health Service and Development Corp Past Accepting new patients
Southern Illinois Medical Services, NFP PastSince Jan 26, 2026 Accepting new patients

Locations

203 Bailey Ln
Ste 1
Benton, IL 62812
Phone (618) 438-5670

2601 W Main St
Carbondale, IL 62901
Phone (618) 351-7300

404 S Lewis Ln
Carbondale, IL 62901
Phone (618) 319-4076

1006 S Division St
Carterville, IL 62918
Phone (618) 985-4841

109 California St
Carterville, IL 62918
Phone (618) 985-8221

117 E Clark St
Harrisburg, IL 62946
Phone (618) 252-8625

405 Rushing Dr
Herrin, IL 62948
Phone (618) 993-3300

1506 Sioux Dr
Marion, IL 62959
Phone (618) 997-5270

3111 Williamson County Pkwy
Marion, IL 62959
Phone (618) 997-3647

502 W Saint Louis St
Ste 4
West Frankfort, IL 62896
Phone (618) 937-3400

Interoperability endpoints

  • Direct secure messaging: hgates86235@sih.direct-ci.com
  • Direct secure messaging: holly.gates.1@14668.direct.athenahealth.com

Organizations & group practices 6

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 5

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": "1533686400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1770163200000",
    "number": "1063991206",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 3988",
            "city": "CARBONDALE",
            "state": "IL",
            "postal_code": "629023988",
            "telephone_number": "618-457-5200"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "203 BAILEY LN STE 1",
            "city": "BENTON",
            "state": "IL",
            "postal_code": "628122266",
            "telephone_number": "618-438-5670",
            "fax_number": "618-438-5709"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2601 W Main St",
            "address_purpose": "LOCATION",
            "city": "Carbondale",
            "state": "IL",
            "postal_code": "629011031",
            "country_code": "US",
            "telephone_number": "618-549-5361",
            "fax_number": "618-351-4878",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "405 Rushing Dr",
            "address_purpose": "LOCATION",
            "city": "Herrin",
            "state": "IL",
            "postal_code": "629483730",
            "country_code": "US",
            "telephone_number": "618-993-3300",
            "fax_number": "618-993-0262",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "117 E Clark St",
            "address_purpose": "LOCATION",
            "city": "Harrisburg",
            "state": "IL",
            "postal_code": "629462702",
            "country_code": "US",
            "telephone_number": "618-252-8625",
            "fax_number": "618-351-4859",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "502 W Saint Louis St Ste 4",
            "address_purpose": "LOCATION",
            "city": "West Frankfort",
            "state": "IL",
            "postal_code": "628961968",
            "country_code": "US",
            "telephone_number": "618-937-3400",
            "fax_number": "618-932-9010",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "GATES",
        "first_name": "HOLLY",
        "middle_name": "ANN",
        "name_prefix": "Mrs.",
        "credential": "NP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2018-08-08",
        "last_updated": "2026-02-04",
        "certification_date": "2026-02-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "IL",
            "license": "277001378",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "hgates86235@sih.direct-ci.com",
            "affiliation": "N",
            "address_1": "203 Bailey Ln Ste 1",
            "city": "Benton",
            "state": "IL",
            "country_code": "US",
            "postal_code": "628122266",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "hgates86235@sih.direct-ci.com",
            "affiliation": "N",
            "address_1": "117 E Clark St",
            "city": "Harrisburg",
            "state": "IL",
            "country_code": "US",
            "postal_code": "629462702",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "hgates86235@sih.direct-ci.com",
            "affiliation": "N",
            "address_1": "2601 W Main St",
            "city": "Carbondale",
            "state": "IL",
            "country_code": "US",
            "postal_code": "629011031",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "hgates86235@sih.direct-ci.com",
            "affiliation": "N",
            "address_1": "502 W Saint Louis St Ste 4",
            "city": "West Frankfort",
            "state": "IL",
            "country_code": "US",
            "postal_code": "628961968",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "hgates86235@sih.direct-ci.com",
            "affiliation": "N",
            "address_1": "405 Rushing Dr",
            "city": "Herrin",
            "state": "IL",
            "country_code": "US",
            "postal_code": "629483730",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "first_name": "HOLLY",
            "last_name": "RYDER",
            "prefix": "MRS.",
            "credential": "APRN",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Benton, IL

Sources for this page

Verify at the official NPI Registry.