Holly Keddington, PA-C

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

7947-23 Issued in WI

Practice address

105 Highland Ter
Waterloo, WI 53594-2217

Phone

(920) 478-2141

Fax

(920) 478-3820

NPI assigned

Jul 1, 2022

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other identifiers 1

Electronic endpoints 2

Medicare fee-for-service enrollment

Enrolled in WI

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

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: hkeddington520855@direct-ehr-ssmhc.com

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.

• Dean Health Systems, Inc

  • Allergy & Immunology Physician
  • Madison, WI
  • NPI 1053358846
  Medicare reassignment NPD
• Dean Health Systems, Inc.

  • Durable Medical Equipment & Medical Supplies
  • Portage, WI
  • NPI 1427085679
  NPD
• Luis Alesandro Larrazabal Martinez MD PC

  • Pediatrics Physician
  • San Francisco, CA
  • NPI 1649910589
  NPD (past)

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

{
    "created_epoch": "1656633600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1726531200000",
    "number": "1194458794",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "105 HIGHLAND TER",
            "city": "WATERLOO",
            "state": "WI",
            "postal_code": "535942217",
            "telephone_number": "920-478-2141",
            "fax_number": "920-478-3820"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "105 HIGHLAND TER",
            "city": "WATERLOO",
            "state": "WI",
            "postal_code": "535942217",
            "telephone_number": "920-478-2141",
            "fax_number": "920-478-3820"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KEDDINGTON",
        "first_name": "HOLLY",
        "credential": "PA-C",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2022-07-01",
        "last_updated": "2024-09-17",
        "certification_date": "2024-09-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "WI",
            "license": "7947-23",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1194458794",
            "state": "WI"
        }
    ],
    "endpoints": [
        {
            "endpointType": "FHIR",
            "endpointTypeDescription": "FHIR URL",
            "endpoint": "https://fhir.ssmhc.com/fhir/api/FHIR/DSTU2/",
            "affiliation": "N",
            "use": "OTHER",
            "useDescription": "Other",
            "useOtherDescription": "FHIR API",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "CCD",
            "address_1": "105 Highland Ter",
            "city": "Waterloo",
            "state": "WI",
            "country_code": "US",
            "postal_code": "535942217",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "hkeddington520855@direct-ehr-ssmhc.com",
            "affiliation": "N",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "hkeddington520855@direct-ehr-ssmhc.com",
            "address_1": "105 Highland Ter",
            "city": "Waterloo",
            "state": "WI",
            "country_code": "US",
            "postal_code": "535942217",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Dean Health Systems, Inc.
• DRS Anderson & Arena
• Floxy Abilitynest LLC
• Cassandra Hartwig, NP
• Karen Lynette Jiles
• Lavender Lotus Acupuncture LLC
• Anne Leclaire-Thoma, RN
• David M Martin, AA-C
• Emily R Marty, SLP
• Jennifer Rose McKay Sillman, LPC

• Physician Assistant in Waterloo, WI
• Providers in Waterloo, WI by specialty
• Physician Assistant in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 17, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.