Dale R Holdiman, MD

Primary specialty

Internal Medicine PhysicianTaxonomy code 207R00000X

License

20689 Issued in IA

Practice address

624 Jones St
Ste 5400
Sioux City, IA 51105-1924

Phone

(712) 279-2510

Fax

(712) 279-2519

NPI assigned

May 5, 2006

Last updated

Oct 17, 2007By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 4

Medicare fee-for-service enrollment

Enrolled in IA

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

All facility ownership & control disclosures 2

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

Owned or controlled facilities with NPI records 2

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

• St Croix Hospice LLC

  dba St. Croix Hospice

  • Community Based Hospice Care Agency
  • Spirit Lake, IA
  • NPI 1659786259

  Operational/Managerial Control, W-2 Managing Employee

  CMS ownership
• St Croix Hospice LLC

  dba St Croix Hospice

  • Community Based Hospice Care Agency
  • Sioux Falls, SD
  • NPI 1437733094

  Operational/Managerial Control, W-2 Managing Employee

  CMS ownership

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.

• Siouxland Regional Cancer Center

  dba June E Nylen Cancer Center

  • Hematology & Oncology Physician
  • Sioux City, IA
  • NPI 1114904604
  Medicare reassignment NPD
• Mercy Medical Services

  dba Cardiology Outreach Clinics to Nebraska

  • Internal Medicine Physician
  • Sioux City, IA
  • NPI 1548203193
  NPD (past)
• Northwest Iowa Hospital Corporation

  dba St. Luke's Regional Medical Center

  • Emergency Medical Services (Emergency Medicine) Physician
  • Sioux City, IA
  • NPI 1215962550
  NPD (past)
• St Lukes Health Resources

  dba St Lukes Clinic Network

  • Family Medicine Physician
  • Sioux City, IA
  • NPI 1528001492

  Internal Medicine

  NPD (past)
• Mercy Medical Services

  dba MercyOne South Sioux Family Medicine

  • Family Medicine Physician
  • South Sioux City, NE
  • NPI 1043251754
  NPD (past)
• St Croix Hospice LLC

  dba St. Croix Hospice

  • Community Based Hospice Care Agency
  • Omaha, NE
  • NPI 1740553940
  NPD (past)

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

{
    "created_epoch": "1146787200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1192579200000",
    "number": "1306894050",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 328",
            "city": "SIOUX CITY",
            "state": "IA",
            "postal_code": "511020328",
            "telephone_number": "712-279-5830",
            "fax_number": "712-279-5883"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "624 JONES ST",
            "address_2": "STE 5400",
            "city": "SIOUX CITY",
            "state": "IA",
            "postal_code": "511051924",
            "telephone_number": "712-279-2510",
            "fax_number": "712-279-2519"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HOLDIMAN",
        "first_name": "DALE",
        "middle_name": "R",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-05-05",
        "last_updated": "2007-10-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "IA",
            "license": "20689",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100251443-00",
            "state": "IA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "7782140",
            "state": "IA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "3164657",
            "state": "IA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "WELLMARK BCBS",
            "identifier": "36901",
            "state": "IA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Kimberly Ann Hofmeister
• Amanda Lynn Hogan, NP-C
• Kathleen June Hogancamp
• Rita Rae Hogue, CRNA
• Tiffany Holbrook, LMHC
• Angela Holevas, PHARMD
• Joshua Hollingshead, MD
• Thomas N Holm
• Lois Jean Holmes, LISW
• Kaylee Ann Holsinger

• Internal Medicine Physician in Sioux City, IA
• Providers in Sioux City, IA by specialty
• Internal Medicine Physician in Iowa

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 17, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; facility enrollments, owners and changes of ownership; Provider of Services certification data; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.