NPIMap

Individual provider Active NPI

Adele B Holmes, MD

  • Pediatrics Physician
  • Benton, AR
National Provider Identifier
1154383958
Registry record updated Jan 25, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatrics PhysicianTaxonomy code 208000000X
License
E0670 Issued in AR
Practice address
2301 Springhill Road
Suite 200
Benton, AR 72019
Phone
(501) 315-0078
Fax
(501) 943-3016
NPI assigned
Apr 5, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 25, 2011

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatrics Physician 208000000X E0670 AR Primary

Addresses

Primary practice location

2301 Springhill Road
Suite 200
Benton, AR 72019

Mailing address

2301 Springhill Road
Suite 200
Benton, AR 72019
Phone (501) 315-0078

Other identifiers 5

IdentifierTypeStateIssuer
5902223OtherARAETNA PROVIDER ID
129511001MedicaidAR
5K100OtherARBCBS PRIVIDER ID
1220059OtherARUNITED HEALTH CARE ID#
16838000000OtherARQUALCHOICE PRIOVIDER ID

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
E0670ARMDPediatrics Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Central Arkansas Pediatric Clinic Past Accepting new patients

Organizations & group practices 1

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.

NPI Registry JSON

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

{
    "created_epoch": "1144195200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1295913600000",
    "number": "1154383958",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2301 SPRINGHILL ROAD",
            "address_2": "SUITE 200",
            "city": "BENTON",
            "state": "AR",
            "postal_code": "72019",
            "telephone_number": "501-315-0078",
            "fax_number": "501-943-3016"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2301 SPRINGHILL ROAD",
            "address_2": "SUITE 200",
            "city": "BENTON",
            "state": "AR",
            "postal_code": "72019",
            "telephone_number": "501-315-0078",
            "fax_number": "501-943-3016"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HOLMES",
        "first_name": "ADELE",
        "middle_name": "B",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-04-05",
        "last_updated": "2011-01-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "AR",
            "license": "E0670",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AETNA PROVIDER ID",
            "identifier": "5902223",
            "state": "AR"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "129511001",
            "state": "AR"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS PRIVIDER ID",
            "identifier": "5K100",
            "state": "AR"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "UNITED HEALTH CARE ID#",
            "identifier": "1220059",
            "state": "AR"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "QUALCHOICE PRIOVIDER ID",
            "identifier": "16838000000",
            "state": "AR"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Benton, AR

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 25, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.