NPIMap

Individual provider Active NPI

David Glenn Holst, MD

  • Family Medicine Physician
  • Mount Shasta, CA
National Provider Identifier
1164416764
Registry record updated Sep 19, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
G76027 Issued in CA
Practice address
824 Pine St
Mount Shasta, CA 96067-2137
Phone
(530) 926-4528
Fax
(530) 926-5070
NPI assigned
Sep 9, 2005
Last updated
Sep 19, 2013By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 19, 2013

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 G76027 CA Primary
Obstetrics Physician 207VX0000X G76027 CA

Addresses

Primary practice location

824 Pine St
Mount Shasta, CA 96067-2137

Mailing address

PO Box 339
Mount Shasta, CA 96067-0339
Phone (530) 926-5613

Other identifiers 2

IdentifierTypeStateIssuer
080080840OtherRAILROAD MEDICARE
00G760270MedicaidCA

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA
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
I20080529000454 CA Practitioner - Family Practice 5799710497 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
University of California, Irvine, California College of Medicine, 1991
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Dignity HealthGroup PAC ID 2062320559, 88 clinicians

Practice addresses (Care Compare)

914 Pine St
Mount Shasta, CA 96067-2143
Phone (530) 926-7131

Hospital & facility affiliations

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
McCloud Healthcare Clinic, Inc. Current Accepting new patients
Dignity Health CurrentSince Apr 13, 2020 Accepting new patients
McCloud Healthcare Clinic, Inc. CurrentSince Dec 29, 2018 Accepting new patients
McCloud Healthcare Clinic, Inc. CurrentSince Dec 29, 2018 Accepting new patients
Dignity Health CurrentSince Apr 13, 2020 Accepting new patients
Southern Monterey County Memorial Hospital Past Accepting new patients
Dignity Health Past Accepting new patients
Dignity Health Past Accepting new patients
Dignity Health Past Accepting new patients
Dignity Health Past Accepting new patients

Locations

4309 Stagecoach Rd
Dunsmuir, CA 96025
Phone (530) 235-2205

824 Pine St
Mount Shasta, CA 96067
Phone (530) 926-4528

828 Pine St
Mount Shasta, CA 96067
Phone (530) 926-4528

912 Pine St
Mount Shasta, CA 96067
Phone (530) 926-3653

914 Pine St
Mount Shasta, CA 96067
Phone (503) 926-6111

310 Hartnell Ave
Ste Ac
Redding, CA 96002
Phone (530) 225-6390

Organizations & group practices 10

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.

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": "1126224000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1379548800000",
    "number": "1164416764",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 339",
            "city": "MOUNT SHASTA",
            "state": "CA",
            "postal_code": "960670339",
            "telephone_number": "530-926-5613",
            "fax_number": "530-926-8798"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "824 PINE ST",
            "city": "MOUNT SHASTA",
            "state": "CA",
            "postal_code": "960672137",
            "telephone_number": "530-926-4528",
            "fax_number": "530-926-5070"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HOLST",
        "first_name": "DAVID",
        "middle_name": "GLENN",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-09-09",
        "last_updated": "2013-09-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "CA",
            "license": "G76027",
            "primary": true
        },
        {
            "code": "207VX0000X",
            "taxonomy_group": "",
            "desc": "Obstetrics & Gynecology, Obstetrics",
            "state": "CA",
            "license": "G76027",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "080080840",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00G760270",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Mount Shasta, CA

Sources for this page

Verify at the official NPI Registry.