NPIMap

Organization Active NPI

Holon Health Great Lakes, P.C.

Doing business as Holon Health

  • Family Medicine Physician
  • Glen Allen, VA
National Provider Identifier
1194414805
Registry record updated Oct 9, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
Legal business name
HOLON HEALTH GREAT LAKES, P.C.
Doing business as
Holon Health
Practice address
11551 Nuckols Rd Ste R
Glen Allen, VA 23059-5565
Phone
(877) 465-6650
Fax
(804) 294-2775
NPI assigned
May 8, 2023
Last updated
Oct 9, 2026By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 9, 2026

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

Authorized official

Name
Jason Herzog
Title
Ceo
Phone
(877) 754-4694

Specialties & licenses 7

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Psychologist 103TC0700X
Family Medicine Physician 207Q00000X Primary
Internal Medicine Physician 207R00000X
Addiction Psychiatry Physician 2084P0802X
Nurse Practitioner 363L00000X
Case Manager/Care Coordinator 171M00000X
Addiction Medicine (Preventive Medicine) Physician 2083A0300X

Addresses

Primary practice location

11551 Nuckols Rd Ste R
Glen Allen, VA 23059-5565

Mailing address

3540 Pump Rd # 1188
Richmond, VA 23233-1115
Phone (877) 754-4694

Other practice location 1

1209 Mountain Road Pl NE Ste N
Albuquerque, NM 87110-7845
Phone (877) 465-6650

Other practice location 2

1902 N Date St Ste 100
Truth OR Consequences, NM 87901-3701
Phone (877) 465-6650

Other practice location 3

145 Pine Haven Shores Rd Ste 1000A
Shelburne, VT 05482-7812
Phone (877) 754-4694

Other practice location 4

212 N 2nd St Ste 100
Richmond, KY 40475-1408
Phone (877) 465-6650

Other practice location 5

116 Agnes Rd Ste 200
Knoxville, TN 37919-6306
Phone (877) 465-6650

Other practice location 6

8401 Mayland Dr Ste A
Richmond, VA 23294-4648
Phone (877) 465-6650

Other practice location 7

221 Main St Ste N
Nashua, NH 03060-2913
Phone (877) 754-4694

Other practice location 8

2222 W Grand River Ave Ste A
Okemos, MI 48864-1604
Phone (877) 465-6650

Other practice location 9

4030 Wake Forest Rd Ste 349
Raleigh, NC 27609-0010
Phone (877) 465-6650

Other practice location 10

4539 N 22nd St Ste N
Phoenix, AZ 85016-4639
Phone (877) 465-6650

Other practice location 11

117 S Lexington St Ste 100
Harrisonville, MO 64701-2444
Phone (877) 465-6650

Other practice location 12

1717 N St NW Ste 1
Washington, DC 20036-2827
Phone (877) 754-4694

Other practice location 13

9905 S Pennsylvania Ave Ste A
Oklahoma City, OK 73159-6920
Phone (877) 754-4694

Other practice location 14

1001 Bishop St Ste 2685Aa
Honolulu, HI 96813-3429
Phone (877) 754-4694

Other practice location 15

5534 Saint Joe Rd
Fort Wayne, IN 46835-3328
Phone (877) 465-6650

Other names 1

  • Holon Health Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IN, AZ, VA, TN, MO, NM, MI, KY, NC, MA, PA11 enrollments

Enrollment records 11

Enrollment IDStateProvider typePAC IDDetails
O20230803002746 IN Part B Supplier - Clinic/Group Practice 1759742919 Receives reassigned benefits from 21 practitioners
Practice locations: Fort Wayne, IN
O20240104004368 AZ Part B Supplier - Clinic/Group Practice 1759742919 Receives reassigned benefits from 16 practitioners
Practice locations: Nogales, AZ; Phoenix, AZ
O20240916003555 VA Part B Supplier - Clinic/Group Practice 1759742919 Receives reassigned benefits from 7 practitioners
Practice locations: Glen Allen, VA; Richmond, VA
O20250218000482 TN Part B Supplier - Clinic/Group Practice 1759742919 Receives reassigned benefits from 4 practitioners
Practice locations: Knoxville, TN; Memphis, TN; Murfreesboro, TN; Nashville, TN
O20250418000541 MO Part B Supplier - Clinic/Group Practice 1759742919 Receives reassigned benefits from 2 practitioners
Practice locations: Clayton, MO; Hillsboro, MO; Saint Charles, MO; Saint Louis, MO; Troy, MO; Warrenton, MO
O20250529003807 NM Part B Supplier - Clinic/Group Practice 1759742919 Receives reassigned benefits from 5 practitioners
Practice locations: Albuquerque, NM
O20250626003983 MI Part B Supplier - Clinic/Group Practice 1759742919 Receives reassigned benefits from 6 practitioners
Practice locations: Detroit, MI
O20250717002695 KY Part B Supplier - Clinic/Group Practice 1759742919 Receives reassigned benefits from 3 practitioners
Practice locations: Elizabethtown, KY; Lexington, KY; Louisville, KY; Richmond, KY
O20251114001448 NC Part B Supplier - Clinic/Group Practice 1759742919 Receives reassigned benefits from 2 practitioners
Practice locations: Raleigh, NC
O20260309002997 MA Part B Supplier - Clinic/Group Practice 1759742919 Receives reassigned benefits from 2 practitioners
Practice locations: Pittsfield, MA
O20260527001925 PA Part B Supplier - Clinic/Group Practice 1759742919 Receives reassigned benefits from 1 practitioner
Practice locations: State College, PA

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
03D2292722Holon Health Great Lakes, PC4539 N 22ND St Ste N, Phoenix, AZ 85016Certificate of waiverOct 29, 2027
15D2293257Holon Health Great Lakes, PC5534 Saint Joe Road, Fort Wayne, IN 46835Certificate of waiverNov 5, 2027
49D2323411Holon Health Great Lakes, PC11551 Nuckols Road, Ste R, Glen Allen, VA 23059Certificate of waiverMay 6, 2027

National Provider Directory

National Provider Directory
Tax ID family
Holon Health8 organizations share this tax ID, including this one

Other organizations with this tax ID 7

Organizations that report the same tax identification number in the National Provider Directory.

Locations

4433 E Broadway Blvd
Ste 101
Tucson, AZ 85711

5650 S 12th Ave
Ste 132
Tucson, AZ 85706

119 N Hamilton St
Georgetown, KY 40324

12555 Grand River Ave
Ste 100
Detroit, MI 48204

950 Francis Pl
Ste 104
Clayton, MO 63105

10644 Business 21
Hillsboro, MO 63050

400 N Tucker Blvd
Saint Louis, MO 63101

102 E Main St
Warrenton, MO 63383
Phone (636) 456-1816

330 Innovation Blvd
Fl 2
State College, PA 16803
Phone (814) 880-1958

805 S Church St
Ste 2
Murfreesboro, TN 37130

404 James Robertson Pkwy
Ste 1200
Nashville, TN 37219

12077 Gayton Rd
Richmond, VA 23238
Phone (804) 359-5851

3540 Pump Rd
Richmond, VA 23233
Phone (804) 404-6270

Practitioners & affiliated clinicians

Practitioners 40

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 40

NPI Registry JSON

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

{
    "created_epoch": "1683504000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1791504000000",
    "number": "1194414805",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3540 PUMP RD # 1188",
            "city": "RICHMOND",
            "state": "VA",
            "postal_code": "232331115",
            "telephone_number": "877-754-4694",
            "fax_number": "804-294-2775"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11551 NUCKOLS RD STE R",
            "city": "GLEN ALLEN",
            "state": "VA",
            "postal_code": "230595565",
            "telephone_number": "877-465-6650",
            "fax_number": "804-294-2775"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1209 Mountain Road Pl NE Ste N",
            "address_purpose": "LOCATION",
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            "postal_code": "871107845",
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            "country_name": "United States",
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        },
        {
            "address_1": "1902 N Date St Ste 100",
            "address_purpose": "LOCATION",
            "city": "Truth OR Consequences",
            "state": "NM",
            "postal_code": "879013701",
            "country_code": "US",
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            "fax_number": "804-294-2775",
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        },
        {
            "address_1": "145 Pine Haven Shores Rd Ste 1000A",
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            "country_name": "United States",
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        },
        {
            "address_1": "212 N 2nd St Ste 100",
            "address_purpose": "LOCATION",
            "city": "Richmond",
            "state": "KY",
            "postal_code": "404751408",
            "country_code": "US",
            "telephone_number": "877-465-6650",
            "fax_number": "804-294-2775",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "116 Agnes Rd Ste 200",
            "address_purpose": "LOCATION",
            "city": "Knoxville",
            "state": "TN",
            "postal_code": "379196306",
            "country_code": "US",
            "telephone_number": "877-465-6650",
            "fax_number": "804-294-2775",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "8401 Mayland Dr Ste A",
            "address_purpose": "LOCATION",
            "city": "Richmond",
            "state": "VA",
            "postal_code": "232944648",
            "country_code": "US",
            "telephone_number": "877-465-6650",
            "fax_number": "804-294-2775",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "221 Main St Ste N",
            "address_purpose": "LOCATION",
            "city": "Nashua",
            "state": "NH",
            "postal_code": "030602913",
            "country_code": "US",
            "telephone_number": "877-754-4694",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "2222 W Grand River Ave Ste A",
            "address_purpose": "LOCATION",
            "city": "Okemos",
            "state": "MI",
            "postal_code": "488641604",
            "country_code": "US",
            "telephone_number": "877-465-6650",
            "fax_number": "804-294-2775",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "4030 Wake Forest Rd Ste 349",
            "address_purpose": "LOCATION",
            "city": "Raleigh",
            "state": "NC",
            "postal_code": "276090010",
            "country_code": "US",
            "telephone_number": "877-465-6650",
            "fax_number": "804-294-2775",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "4539 N 22nd St Ste N",
            "address_purpose": "LOCATION",
            "city": "Phoenix",
            "state": "AZ",
            "postal_code": "850164639",
            "country_code": "US",
            "telephone_number": "877-465-6650",
            "fax_number": "804-924-2775",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "117 S Lexington St Ste 100",
            "address_purpose": "LOCATION",
            "city": "Harrisonville",
            "state": "MO",
            "postal_code": "647012444",
            "country_code": "US",
            "telephone_number": "877-465-6650",
            "fax_number": "804-294-2775",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1717 N St NW Ste 1",
            "address_purpose": "LOCATION",
            "city": "Washington",
            "state": "DC",
            "postal_code": "200362827",
            "country_code": "US",
            "telephone_number": "877-754-4694",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "9905 S Pennsylvania Ave Ste A",
            "address_purpose": "LOCATION",
            "city": "Oklahoma City",
            "state": "OK",
            "postal_code": "731596920",
            "country_code": "US",
            "telephone_number": "877-754-4694",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1001 Bishop St Ste 2685Aa",
            "address_purpose": "LOCATION",
            "city": "Honolulu",
            "state": "HI",
            "postal_code": "968133429",
            "country_code": "US",
            "telephone_number": "877-754-4694",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "5534 Saint Joe Rd",
            "address_purpose": "LOCATION",
            "city": "Fort Wayne",
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            "postal_code": "468353328",
            "country_code": "US",
            "telephone_number": "877-465-6650",
            "fax_number": "804-294-2775",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "HOLON HEALTH GREAT LAKES, P.C.",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-05-08",
        "last_updated": "2026-10-09",
        "certification_date": "2026-10-09",
        "status": "A",
        "authorized_official_last_name": "HERZOG",
        "authorized_official_first_name": "JASON",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "877-754-4694"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "2084P0802X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Addiction Psychiatry",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "171M00000X",
            "taxonomy_group": "",
            "desc": "Case Manager/Care Coordinator",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "2083A0300X",
            "taxonomy_group": "",
            "desc": "Preventive Medicine, Addiction Medicine",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Holon Health",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Glen Allen, VA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 9, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.