Active NPI
Kevin R. Holbert, M.D.
- Addiction Medicine (Psychiatry & Neurology) Physician
- Jacksonville, FL
National Provider Identifier
1376768440
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Addiction Medicine (Psychiatry & Neurology) Physician
- License
- ME117810
- Practice address
- 1900 Corporate Square Blvd
Jacksonville, FL 32216-1941 - Phone
- (904) 899-4500
- Fax
- (904) 899-4538
- NPI assigned
- Apr 16, 2007
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Addiction Medicine (Psychiatry & Neurology) Physician | 2084A0401X | ME117810 | FL | Primary |
| Family Medicine Physician | 207Q00000X | 69866 | GA |
Addresses
Primary practice location
1900 Corporate Square Blvd
Jacksonville, FL 32216-1941
Mailing address
1900 Corporate Square Blvd
Jacksonville, FL 32216-1941
Phone (904) 899-4500
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Eligible to order & refer
- Part B services: No
- Medical equipment: Yes
- Home health: No
- Power mobility devices: Yes
- Hospice: No
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 69866 | GA | MD | Family Medicine Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Lakeview Health Systems, LLC | Past | Accepting new patients |
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 and National Provider Directory roles.
-
- Substance Abuse Rehabilitation Facility
- Jacksonville, FL
- NPI 1760548184
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1176681600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1705881600000",
"number": "1376768440",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1900 CORPORATE SQUARE BLVD",
"city": "JACKSONVILLE",
"state": "FL",
"postal_code": "322161941",
"telephone_number": "904-899-4500",
"fax_number": "904-899-4538"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1900 CORPORATE SQUARE BLVD",
"city": "JACKSONVILLE",
"state": "FL",
"postal_code": "322161941",
"telephone_number": "904-899-4500",
"fax_number": "904-899-4538"
}
],
"practiceLocations": [],
"basic": {
"last_name": "HOLBERT",
"first_name": "KEVIN",
"middle_name": "R.",
"credential": "M.D.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2007-04-16",
"last_updated": "2024-01-22",
"certification_date": "2024-01-22",
"status": "A"
},
"taxonomies": [
{
"code": "2084A0401X",
"taxonomy_group": "",
"desc": "Psychiatry & Neurology, Addiction Medicine",
"state": "FL",
"license": "ME117810",
"primary": true
},
{
"code": "207Q00000X",
"taxonomy_group": "",
"desc": "Family Medicine",
"state": "GA",
"license": "69866",
"primary": false
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Jacksonville, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 22, 2024; 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.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.