Individual provider Active NPI

Fred D Holmes, M.D.

  • Anesthesiology Physician
  • Phoenix, AZ
National Provider Identifier
1104879584
Registry record updated Mar 4, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Anesthesiology PhysicianTaxonomy code 207L00000X
License
28917 Issued in AZ
Practice address
300 W Clarendon Ave
Suite 142
Phoenix, AZ 85013-3449
Phone
(602) 234-1803
Fax
(602) 234-3748
NPI assigned
May 18, 2006
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Mar 4, 2016

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Anesthesiology Physician 207L00000X 28917 AZ Primary

Addresses

Primary practice location

300 W Clarendon Ave
Suite 142
Phoenix, AZ 85013-3449

Mailing address

PO Box 36680
Phoenix, AZ 85067-6680
Phone (602) 234-1803

Other identifiers 1

IdentifierTypeStateIssuer
558314MedicaidAZ

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in AZ
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20040309001452 AZ Practitioner - Anesthesiology 5294623393 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Anesthesiology
Education
University of California, San Francisco School of Medicine, 1979
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Pca AnesthesiaGroup PAC ID 1658675558, 54 clinicians

Practice addresses (Care Compare)

300 W Clarendon Ave
Suite 142
Phoenix, AZ 85013-3449
Phone (602) 234-1803

Hospital & facility affiliations

  • St Josephs Hospital and Medical Center Hospital, Phoenix, AZ, CCN 030024

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
28917AZMDAnesthesiology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Pca Anesthesia Anesthesiology CurrentSince Apr 20, 2019 Accepting new patients
District Medical Group, Inc CurrentSince Jul 6, 2021 Accepting new patients
District Medical Group, Inc CurrentSince Jul 6, 2021 Accepting new patients
District Medical Group, Inc Current Accepting new patients

Locations

300 W Clarendon Ave
Ste 142
Phoenix, AZ 85013
Phone (602) 234-1803

1111 E McDowell Rd
Phoenix, AZ 85006
Phone (602) 239-2000

350 W Thomas Rd
Phoenix, AZ 85013
Phone (480) 339-5001

3141 N 3rd Ave
Phoenix, AZ 85013
Phone (602) 914-1520

Organizations & group practices 4

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 4

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": "1147910400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1457049600000",
    "number": "1104879584",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 36680",
            "city": "PHOENIX",
            "state": "AZ",
            "postal_code": "850676680",
            "telephone_number": "602-234-1803",
            "fax_number": "602-234-3748"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "300 W CLARENDON AVE",
            "address_2": "SUITE 142",
            "city": "PHOENIX",
            "state": "AZ",
            "postal_code": "850133449",
            "telephone_number": "602-234-1803",
            "fax_number": "602-234-3748"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HOLMES",
        "first_name": "FRED",
        "middle_name": "D",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-05-18",
        "last_updated": "2016-03-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207L00000X",
            "taxonomy_group": "",
            "desc": "Anesthesiology",
            "state": "AZ",
            "license": "28917",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "558314",
            "state": "AZ"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Phoenix, AZ

Sources for this page

Verify at the official NPI Registry.