Individual provider Active NPI

Jaime Marie Holthaus, APRN

  • Family Nurse Practitioner
  • Bentonville, AR
National Provider Identifier
1194210070
Registry record updated Jun 25, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
A005688 Issued in AR
Practice address
3101 SE 14TH St
Bentonville, AR 72712-4900
Phone
(479) 986-6090
NPI assigned
Jun 25, 2018
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 25, 2018

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X A005688 AR Primary

Addresses

Primary practice location

3101 SE 14TH St
Bentonville, AR 72712-4900

Mailing address

713 Coulter Rd
Sherwood, AR 72120-5917
Phone (501) 864-9460

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20180731002231 AR Practitioner - Nurse Practitioner 2466700984 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2018
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

3101 SE 14TH St
Bentonville, AR 72712-4900
Phone (479) 631-2100

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Mercy Health Northwest Arkansas Communities Current Accepting new patients
Mercy Health Northwest Arkansas Communities CurrentSince Jul 16, 2018 Accepting new patients
Mercy Health Northwest Arkansas Communities CurrentSince Jul 16, 2018 Accepting new patients
Mercy Northwest Arkansas Ambulatory Services LLC CurrentSince May 11, 2021 Accepting new patients

Locations

3101 SE 14th St
Bentonville, AR 72712
Phone (479) 631-2100

1000 SE 13th Ct
Bentonville, AR 72712
Phone (479) 273-9056

2012 S Promenade Blvd
Rogers, AR 72758
Phone (479) 616-1485

2708 S Rife Medical Ln
Ste T30
Rogers, AR 72758
Phone (479) 338-3999

Interoperability endpoints

  • Direct secure messaging: jholthaus987301@directc.mercy.net

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 2

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": "1529884800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1529884800000",
    "number": "1194210070",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "713 COULTER RD",
            "city": "SHERWOOD",
            "state": "AR",
            "postal_code": "721205917",
            "telephone_number": "501-864-9460"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3101 SE 14TH ST",
            "city": "BENTONVILLE",
            "state": "AR",
            "postal_code": "727124900",
            "telephone_number": "479-986-6090"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HOLTHAUS",
        "first_name": "JAIME",
        "middle_name": "MARIE",
        "credential": "APRN",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2018-06-25",
        "last_updated": "2018-06-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "AR",
            "license": "A005688",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Bentonville, AR

Sources for this page

Verify at the official NPI Registry.