Individual provider Active NPI

Amy Hollman, MD

  • Family Medicine Physician
  • Brandon, MS
National Provider Identifier
1366451387
Registry record updated Jul 8, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
15461 Issued in MS
Practice address
507 Lakeland PL
Brandon, MS 39047-8257
Phone
(601) 992-2200
Fax
(601) 992-4333
NPI assigned
Aug 7, 2006
Last updated
Jul 8, 2007By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 8, 2007

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 15461 MS Primary

Addresses

Primary practice location

507 Lakeland PL
Brandon, MS 39047-8257

Mailing address

507 Lakeland PL
Brandon, MS 39047-8257
Phone (601) 992-2200

Other identifiers 1

IdentifierTypeStateIssuer
0120887MedicaidMS

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MS
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

Enrollment IDStateProvider typePAC IDDetails
I20101129000670 MS Practitioner - Family Practice 7315926052 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
University of Mississippi School of Medicine, 1996
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Quad Intermed Company LLCGroup PAC ID 6709245954, 42 clinicians

Practice addresses (Care Compare)

1515 Jefferson St
Laurel, MS 39440-4244
Phone (601) 425-4893

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Removal of nail tissue1-10

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
15461MSMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Quad Intermed Company LLC CurrentSince Aug 1, 2023 Accepting new patients
Quad Intermed Company LLC CurrentSince Aug 1, 2023 Accepting new patients
Quad Intermed Company LLC Current Accepting new patients
Quad Intermed Company LLC Past Accepting new patients
First Intermed Corporation Family Medicine Past Accepting new patients

Locations

498 Highway 80 E
Clinton, MS 39056
Phone (601) 200-4800

7300 S Siwell Rd
Jackson, MS 39272
Phone (601) 371-1234

1515 Jefferson St
Laurel, MS 39440
Phone (601) 425-4893

935 Highway 51
Madison, MS 39110
Phone (601) 856-5986

342 Gilchrist Dr
Pearl, MS 39208
Phone (601) 939-0700

1132 Highway 49 S
Richland, MS 39218
Phone (601) 664-1620

308 Corporate Dr
Ridgeland, MS 39157
Phone (601) 898-7500

323 Highway 51
Ridgeland, MS 39157
Phone (601) 898-7915

4204 Clay St
Vicksburg, MS 39183
Phone (601) 200-4560

4204 Clay St
#V
Vicksburg, MS 39183
Phone (601) 619-7717

Organizations & group practices 5

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 1

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": "1154908800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1366451387",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "507 LAKELAND PL",
            "city": "BRANDON",
            "state": "MS",
            "postal_code": "390478257",
            "telephone_number": "601-992-2200",
            "fax_number": "601-992-4333"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "507 LAKELAND PL",
            "city": "BRANDON",
            "state": "MS",
            "postal_code": "390478257",
            "telephone_number": "601-992-2200",
            "fax_number": "601-992-4333"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HOLLMAN",
        "first_name": "AMY",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-08-07",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "MS",
            "license": "15461",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0120887",
            "state": "MS"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Brandon, MS

Sources for this page

Verify at the official NPI Registry.