Mary Holthaus, PA

Primary specialty

Medical Physician AssistantTaxonomy code 363AM0700X

License

C07349 Issued in MD

Practice address

122 Defense Hwy Ste 210
Annapolis, MD 21401-7071

Phone

(410) 266-9694

NPI assigned

Jul 2, 2019

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Other identifiers 1

Electronic endpoints 1

Medicare fee-for-service enrollment

Enrolled in DC, MD, VA3 enrollments

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 3

Specialty

Physician Assistant

Education

Other, 2019

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

MCV Associated PhysiciansGroup PAC ID 4385542117, 1,779 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Medical College of Virginia Hospitals Hospital, Richmond, VA, CCN 490032

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

Practice roles

Locations

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.

• MCV Associated Physicians

  dba MCV Physicians

  • Anesthesiology Physician
  • Richmond, VA
  • NPI 1710959457
  Medicare reassignment Care Compare group
• Daniel Hexter MD PA

  dba Annapolis Neurology Associates

  • Neurology Physician
  • Annapolis, MD
  • NPI 1861686420
  Medicare reassignment NPD
• Privia Medical Group, LLC

  • Internal Medicine Physician
  • Arlington, VA
  • NPI 1013042480

  DC

  Medicare reassignment NPD
• Privia Medical Group, LLC

  • Pain Medicine (Psychiatry & Neurology) Physician
  • Rockville, MD
  • NPI 1811715436
  NPD
• Frederick Health Hospital Inc

  dba Frederick Health Hospital

  • General Acute Care Hospital
  • Frederick, MD
  • NPI 1538165527
  NPD (past)

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

• Virginia Commonwealth University Health System Authority

  dba Medical College of Virginia Hospitals

  • General Acute Care Hospital
  • Richmond, VA
  • NPI 1013091727
  Care Compare affiliation
• Virginia Commonwealth University Health System Authority

  dba VCU Medical Center

  • General Acute Care Hospital
  • Richmond, VA
  • NPI 1437175734
  Care Compare affiliation

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

{
    "created_epoch": "1562025600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1674086400000",
    "number": "1285296913",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "122 DEFENSE HWY STE 210",
            "city": "ANNAPOLIS",
            "state": "MD",
            "postal_code": "214017071",
            "telephone_number": "240-205-5832"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "122 DEFENSE HWY STE 210",
            "city": "ANNAPOLIS",
            "state": "MD",
            "postal_code": "214017071",
            "telephone_number": "410-266-9694"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "130 Love Point Rd Ste 107",
            "address_purpose": "LOCATION",
            "city": "Stevensville",
            "state": "MD",
            "postal_code": "216662132",
            "country_code": "US",
            "telephone_number": "410-266-9694",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "HOLTHAUS",
        "first_name": "MARY",
        "credential": "PA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2019-07-02",
        "last_updated": "2023-01-19",
        "certification_date": "2023-01-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "MD",
            "license": "C07349",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MARYLAND BOARD OF PHYSICIANS",
            "identifier": "C07349",
            "state": "MD"
        }
    ],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "annapolispa",
            "affiliation": "N",
            "address_1": "122 Defense Hwy Ste 210",
            "city": "Annapolis",
            "state": "MD",
            "country_code": "US",
            "postal_code": "214017071",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Holly Green, PA
• Kiara Diane Holmes, BEHAVIOR TECHNICIAN
• Karl Derivas Holschuh, MD
• Edward S Holt, MD
• Kimberly Shaw Lumpkin Holt, ATC
• Mara R. Holton, MD
• Allison M Holtz-Caspar, AUD
• Jonathan R. Holtzman, D.C.
• Honorable Pathways LLC
• Erica Ell Hood, PT

• Medical Physician Assistant in Annapolis, MD
• Providers in Annapolis, MD by specialty
• Medical Physician Assistant in Maryland

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 19, 2023; 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.
• 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.