NPIMap

Individual provider Active NPI

Kevin Patrick O'Halloran, MD

  • Orthopaedic Surgery Physician
  • Panama City, FL
National Provider Identifier
1316243538
Registry record updated Dec 2, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Orthopaedic Surgery PhysicianTaxonomy code 207X00000X
License
MD61143141 Issued in WA
Practice address
2943 Highway 77
Panama City, FL 32405-4411
Phone
(850) 914-7060
Fax
(850) 914-7065
NPI assigned
Feb 4, 2011
Last updated
Dec 2, 2021By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 2, 2021

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Orthopaedic Surgery Physician 207X00000X MD61143141 WA Primary
Orthopaedic Trauma Physician 207XX0801X D77843 MD
Orthopaedic Trauma Physician 207XX0801X ME130258 FL

Addresses

Primary practice location

2943 Highway 77
Panama City, FL 32405-4411

Mailing address

3015 Squalicum Pkwy
Ste 200
Bellingham, WA 98225-1906
Phone (360) 733-2092

Other identifiers 1

IdentifierTypeStateIssuer
019265400MedicaidFL

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MN, ID2 enrollments
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20150916003126 MN Practitioner - Orthopedic Surgery 2961719315 Reassigns benefits to 1 organization
I20200630002371 ID Practitioner - Orthopedic Surgery 2961719315 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Orthopedic Surgery
Education
Georgetown University School of Medicine, 2009
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Pocatello Health Services LLCGroup PAC ID 6608927637, 171 clinicians

Practice addresses (Care Compare)

777 Hospital Way
Pocatello, ID 83201-5175
Phone (208) 239-1720

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Hip replacement1-10
Upper limb (arm) arthroscopy (minimally invasive joint repair)1-10
Melanoma (skin cancer) excision1-10
Removal of tissue16

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
MD61143141WAMDOrthopaedic Surgery Physician
ME130258FLMDOrthopaedic Trauma Physician
D77843MDMDOrthopaedic Trauma Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Pocatello Health Services, LLC CurrentSince Jul 1, 2020 Accepting new patients
Pocatello Health Services, LLC CurrentSince Jul 1, 2020 Accepting new patients
Pocatello Health Services, LLC Current Accepting new patients
Group Health, Inc. CurrentSince Sep 1, 2015 Accepting new patients
Pocatello Hospital LLC Current Accepting new patients
Group Health, Inc. CurrentSince Sep 1, 2015 Accepting new patients
Sacred Heart Health System, Inc. Current Accepting new patients
C. Guy FPS, PLLC Past Accepting new patients
Pocatello Hospital LLC Past Accepting new patients
LHP Texas MD Services Inc Orthopaedic Surgery Past Accepting new patients

Locations

801 E 6th St
Ste 302
Panama City, FL 32401
Phone (850) 747-2010

777 Hospital Way
Pocatello, ID 83201
Phone (208) 239-1000

777 Hospital Way
Ste 201
Pocatello, ID 83201
Phone (208) 239-2260

777 Hospital Way
Ste 202
Pocatello, ID 83201
Phone (208) 239-2640

777 Hospital Way
Ste 204
Pocatello, ID 83201
Phone (208) 239-2110

8600 Nicollet Ave S
Minneapolis, MN 55420
Phone (952) 887-6600

Interoperability endpoints

  • Direct secure messaging: kohalloran290536@ahs.direct-ci.com
  • Direct secure messaging: kohalloran481896@direct.peacehealth.org

Organizations & group practices 10

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 3

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": "1296777600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1638403200000",
    "number": "1316243538",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3015 SQUALICUM PKWY",
            "address_2": "STE 200",
            "city": "BELLINGHAM",
            "state": "WA",
            "postal_code": "982251906",
            "telephone_number": "360-733-2092",
            "fax_number": "360-788-6042"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2943 HIGHWAY 77",
            "city": "PANAMA CITY",
            "state": "FL",
            "postal_code": "324054411",
            "telephone_number": "850-914-7060",
            "fax_number": "850-914-7065"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "O'HALLORAN",
        "first_name": "KEVIN",
        "middle_name": "PATRICK",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2011-02-04",
        "last_updated": "2021-12-02",
        "certification_date": "2021-12-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207X00000X",
            "taxonomy_group": "",
            "desc": "Orthopaedic Surgery",
            "state": "WA",
            "license": "MD61143141",
            "primary": true
        },
        {
            "code": "207XX0801X",
            "taxonomy_group": "",
            "desc": "Orthopaedic Surgery, Orthopaedic Trauma",
            "state": "MD",
            "license": "D77843",
            "primary": false
        },
        {
            "code": "207XX0801X",
            "taxonomy_group": "",
            "desc": "Orthopaedic Surgery, Orthopaedic Trauma",
            "state": "FL",
            "license": "ME130258",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "019265400",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Panama City, FL

Sources for this page

Verify at the official NPI Registry.