Individual provider Active NPI

Patrick Raymond Holmlund, DDS

  • General Practice Dentistry
  • Princess Anne, MD
National Provider Identifier
1114172798
Registry record updated Dec 19, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
13816 Issued in MD
Practice address
12165 Elm St
Princess Anne, MD 21853-1358
Phone
(410) 651-5151
Fax
(410) 651-4256
NPI assigned
Nov 24, 2008
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 19, 2019

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice Dentistry 1223G0001X 13816 MD Primary

Addresses

Primary practice location

12165 Elm St
Princess Anne, MD 21853-1358

Mailing address

PO Box 1978
Salisbury, MD 21802-1978
Phone (410) 749-1015

Other identifiers 1

IdentifierTypeStateIssuer
119591300MedicaidMD

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MD
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: No
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20200205001460 MD Order and Referring Only - DentistPractitioner - Dentist 5890121107

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
13816MDMDClinical Social Worker

Interoperability endpoints

  • Direct secure messaging: patrick.holmlund.1@3167.direct.athenahealth.com

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1227484800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1576713600000",
    "number": "1114172798",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1978",
            "city": "SALISBURY",
            "state": "MD",
            "postal_code": "218021978",
            "telephone_number": "410-749-1015",
            "fax_number": "410-749-0654"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12165 ELM ST",
            "city": "PRINCESS ANNE",
            "state": "MD",
            "postal_code": "218531358",
            "telephone_number": "410-651-5151",
            "fax_number": "410-651-4256"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HOLMLUND",
        "first_name": "PATRICK",
        "middle_name": "RAYMOND",
        "name_prefix": "Dr.",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2008-11-24",
        "last_updated": "2019-12-19",
        "certification_date": "2019-12-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "MD",
            "license": "13816",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "119591300",
            "state": "MD"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Princess Anne, MD

Sources for this page

Verify at the official NPI Registry.