NPIMap

Individual provider Active NPI

Holland Hoyt Haynie III, MD26719

  • Family Medicine Physician
  • Osage Beach, MO
National Provider Identifier
1154419182
Registry record updated Jul 30, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
2024012818 Issued in MO
Practice address
3870 Columbia Ave
Osage Beach, MO 65065-8689
Phone
(573) 708-7600
NPI assigned
Oct 11, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 30, 2024

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X MD26719 OR
Family Medicine Physician 207Q00000X 2024012818 MO Primary

Addresses

Primary practice location

3870 Columbia Ave
Osage Beach, MO 65065-8689

Mailing address

PO Box 777
Richland, MO 65556-0777
Phone (573) 708-7600

Other practice location 1

559 W Washington St
Burns, OR 97720-1441
Phone (541) 573-2074

Other identifiers 3

IdentifierTypeStateIssuer
MD26719OtherORLICENSE
278996MedicaidOR
838331006OtherORBC/BS

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MO
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
I20240622000561 MO Practitioner - Family Practice 2567563331 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Other, 2004
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Richland Medical Center, Inc. 29 clinicians

Practice addresses (Care Compare)

1652 N Business Route 5
Camdenton, MO 65020-6872
Phone (877) 406-2662

304 W Washington Ave
Richland, MO 65556-7101
Phone (573) 836-7053

3870 Columbia Ave
Osage Beach, MO 65065-8689
Phone (877) 406-2662

931 Hwy D
Osage Beach, MO 65065-3169
Phone (877) 406-2661

Hospital & facility affiliations

  • Phoenix Home Care and Hospice Home health agency, Springfield, MO, CCN 267629
  • Lake Regional Health System Hospital, Osage Beach, MO, CCN 260186

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

Practice roles

OrganizationSpecialtyStatusNew patients
Richland Medical Center, Inc. Current Accepting new patients
High Desert Medical Center Family Medicine Past Accepting new patients

Locations

3870 Columbia Ave
Osage Beach, MO 65065
Phone (573) 302-7490

Organizations & group practices 11

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 3

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": "1160524800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1722297600000",
    "number": "1154419182",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 777",
            "city": "RICHLAND",
            "state": "MO",
            "postal_code": "655560777",
            "telephone_number": "573-708-7600",
            "fax_number": "541-573-8893"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3870 COLUMBIA AVE",
            "city": "OSAGE BEACH",
            "state": "MO",
            "postal_code": "650658689",
            "telephone_number": "573-708-7600"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "559 W Washington St",
            "address_purpose": "LOCATION",
            "city": "Burns",
            "state": "OR",
            "postal_code": "977201441",
            "country_code": "US",
            "telephone_number": "541-573-2074",
            "fax_number": "541-573-8893",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "HAYNIE",
        "first_name": "HOLLAND",
        "middle_name": "HOYT",
        "name_prefix": "Dr.",
        "name_suffix": "III",
        "credential": "MD26719",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-10-11",
        "last_updated": "2024-07-30",
        "certification_date": "2024-07-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "OR",
            "license": "MD26719",
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "MO",
            "license": "2024012818",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "LICENSE",
            "identifier": "MD26719",
            "state": "OR"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "278996",
            "state": "OR"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BC/BS",
            "identifier": "838331006",
            "state": "OR"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Osage Beach, MO

Sources for this page

Verify at the official NPI Registry.