NPIMap

Individual provider Active NPI

Paul S Holley, M.D.

  • Family Medicine Physician
  • Bemus Point, NY
National Provider Identifier
1225015696
Registry record updated Nov 30, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
204064 Issued in NY
Practice address
4936 Main St
Bemus Point, NY 14712-9667
Phone
(716) 386-2414
Fax
(716) 386-2437
NPI assigned
Dec 28, 2005
Last updated
Nov 30, 2020By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 30, 2020

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 204064 NY Primary

Addresses

Primary practice location

4936 Main St
Bemus Point, NY 14712-9667

Mailing address

4936 Main St
PO Box 470
Bemus Point, NY 14712-9667
Phone (716) 386-2414

Other identifiers 4

IdentifierTypeStateIssuer
00010198101OtherNYUNIVERA PROVIDER NUMBER
0109568OtherNYINDEPENDENT HEALTH
000524400003OtherNYBC WESTERN NY PROVIDER #
01669929MedicaidNY

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address pholley154596@direct.ahn.org

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NY
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
I20050809000868 NY Practitioner - Family Practice 5799735742 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
JC Edwards School of Medicine, Marshall University, 1993
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Chautauqua Medical Practice PCGroup PAC ID 5294920203, 103 clinicians

Practice addresses (Care Compare)

4936 Main St
Bemus Point, NY 14712-9667
Phone (716) 386-2414

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
93.9 of 100Reported as apm
Quality
85.02
Promoting interoperability
100
Improvement activities
40

Procedures performed for Medicare patients

ProcedureNumber of procedures
Removal of skin lesions1-10

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
204064NYMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Chautauqua Medical Practice, P.C. Family Medicine CurrentSince Apr 12, 2010 Accepting new patients

Locations

189 E Main St
Westfield, NY 14787
Phone (716) 326-4921

Organizations & group practices 1

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 10

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": "1135728000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1606694400000",
    "number": "1225015696",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4936 MAIN ST",
            "address_2": "PO BOX 470",
            "city": "BEMUS POINT",
            "state": "NY",
            "postal_code": "147129667",
            "telephone_number": "716-386-2414",
            "fax_number": "716-386-2437"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4936 MAIN ST",
            "city": "BEMUS POINT",
            "state": "NY",
            "postal_code": "147129667",
            "telephone_number": "716-386-2414",
            "fax_number": "716-386-2437"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HOLLEY",
        "first_name": "PAUL",
        "middle_name": "S",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-12-28",
        "last_updated": "2020-11-30",
        "certification_date": "2020-11-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "NY",
            "license": "204064",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "UNIVERA PROVIDER NUMBER",
            "identifier": "00010198101",
            "state": "NY"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "INDEPENDENT HEALTH",
            "identifier": "0109568",
            "state": "NY"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BC WESTERN NY PROVIDER #",
            "identifier": "000524400003",
            "state": "NY"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "01669929",
            "state": "NY"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "pholley154596@direct.ahn.org",
            "affiliation": "N",
            "address_1": "4936 Main St",
            "city": "Bemus Point",
            "state": "NY",
            "country_code": "US",
            "postal_code": "147129667",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Bemus Point, NY

Sources for this page

Verify at the official NPI Registry.