NPIMap

Individual provider Active NPI

Sara J Holland, PA-C

  • Physician Assistant
  • Madison, WI
National Provider Identifier
1104041623
Registry record updated May 16, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
4220-33 Issued in WI
Practice address
6108 Kilpatrick LN
Madison, WI 53718-3197
Phone
(608) 287-2700
NPI assigned
Apr 17, 2007
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 16, 2023

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X PA10005183 WA
Surgical Physician Assistant 363AS0400X 50003326 OH
Physician Assistant 363A00000X 4220-33 WI Primary

Addresses

Primary practice location

6108 Kilpatrick LN
Madison, WI 53718-3197

Mailing address

6108 Kilpatrick LN
Madison, WI 53718-3197

Other identifiers 3

IdentifierTypeStateIssuer
8501058MedicaidWA
0220568OtherWAL&I
PA10005183OtherWASTATE LICENSE

Other names 1

  • Sara Crookshank Former name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WI
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
I20180321001097 WI Practitioner - Physician Assistant 8921190455 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2006
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Sauk Prairie Healthcare IncGroup PAC ID 8224948054, 122 clinicians

Practice addresses (Care Compare)

260 26TH St
Prairie Du Sac, WI 53578-2203
Phone (608) 643-7574

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
PA10005183WAMDPhysician Assistant
50003326OHMDSurgical Physician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Sauk Prairie Healthcare Inc CurrentSince Jun 19, 2023 Accepting new patients
Sauk Prairie Healthcare Inc Current Accepting new patients
University of Wisconsin Medical Foundation, Inc CurrentSince May 4, 2020 Accepting new patients
Sauk Prairie Healthcare, Inc. CurrentSince Jun 19, 2023 Accepting new patients
University of Wisconsin Medical Foundation, Inc CurrentSince May 4, 2020 Accepting new patients
St Luke'S Methodist Hospital Current Accepting new patients
Sauk Prairie Healthcare Inc Past Accepting new patients

Locations

1 S Park St
Madison, WI 53715
Phone (608) 287-2000

600 Highland Ave
Madison, WI 53792
Phone (608) 263-0325

7974 Uw Health Ct
Middleton, WI 53562
Phone (608) 829-5270

515 22nd Ave
Monroe, WI 53566
Phone (608) 324-1000

260 26th St
Prairie du Sac, WI 53578
Phone (608) 643-2471

250 26th St
Prairie du Sac, WI 53578
Phone (608) 643-2431

Interoperability endpoints

  • Direct secure messaging: sholland750513@direct.unitypoint.org
  • FHIR API: https://fhir.nextgen.com/nge/prod/fhir-api-r4/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 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": "1176768000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1684195200000",
    "number": "1104041623",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6108 KILPATRICK LN",
            "city": "MADISON",
            "state": "WI",
            "postal_code": "537183197"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6108 KILPATRICK LN",
            "city": "MADISON",
            "state": "WI",
            "postal_code": "537183197",
            "telephone_number": "608-287-2700"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HOLLAND",
        "first_name": "SARA",
        "middle_name": "J",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-04-17",
        "last_updated": "2023-05-16",
        "certification_date": "2023-05-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "WA",
            "license": "PA10005183",
            "primary": false
        },
        {
            "code": "363AS0400X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Surgical",
            "state": "OH",
            "license": "50003326",
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "WI",
            "license": "4220-33",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "8501058",
            "state": "WA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "L&I",
            "identifier": "0220568",
            "state": "WA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "STATE LICENSE",
            "identifier": "PA10005183",
            "state": "WA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "SARA",
            "last_name": "CROOKSHANK",
            "credential": "PA-C",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Madison, WI

Sources for this page

Verify at the official NPI Registry.