Individual provider Active NPI

Candice J Holder, PMHNP

  • Psychiatric/Mental Health Nurse Practitioner
  • Rockford, IL
National Provider Identifier
1376976530
Registry record updated Jul 26, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X
License
209018392 Issued in IL
Practice address
1639 N Alpine Rd Ste 260
Rockford, IL 61107-1481
Phone
(815) 395-1500
NPI assigned
Aug 12, 2013
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 26, 2023

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Psychiatric/Mental Health Nurse Practitioner 363LP0808X 209018392 IL Primary

Addresses

Primary practice location

1639 N Alpine Rd Ste 260
Rockford, IL 61107-1481

Mailing address

1639 N Alpine Rd Ste 260
Rockford, IL 61107-1481
Phone (815) 395-1500

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IL
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 1

Enrollment IDStateProvider typePAC IDDetails
I20190730000172 IL Practitioner - Nurse Practitioner 9032353206 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2013
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Rockford Psychiatric Medical Services SCGroup PAC ID 6901089515, 154 clinicians

Practice addresses (Care Compare)

1639 N Alpine Rd
Suite 500
Rockford, IL 61107-1440
Phone (815) 395-1500

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
209018392ILMDPsychiatric/Mental Health Nurse Practitioner
5378-33WIMDPsychiatric/Mental Health Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Rosecrance Inc CurrentSince Jul 23, 2019 Accepting new patients
Rosecrance Inc CurrentSince Jul 23, 2019 Accepting new patients
Rockford Psychiatric Medical Services, S.C. CurrentSince Jan 6, 2023 Accepting new patients
Rosecrance Inc Current Accepting new patients

Locations

1021 N Mulford Rd
Rockford, IL 61107
Phone (815) 387-5600

1639 N Alpine Rd
Ste 260
Rockford, IL 61107
Phone (815) 395-1500

1639 N Alpine Rd
Ste 500
Rockford, IL 61107
Phone (815) 395-1500

1601 University Dr
Rockford, IL 61107
Phone (815) 387-2500

Organizations & group practices 4

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.

NPI Registry JSON

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

{
    "created_epoch": "1376265600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1690329600000",
    "number": "1376976530",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1639 N ALPINE RD STE 260",
            "city": "ROCKFORD",
            "state": "IL",
            "postal_code": "611071481",
            "telephone_number": "815-395-1500"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1639 N ALPINE RD STE 260",
            "city": "ROCKFORD",
            "state": "IL",
            "postal_code": "611071481",
            "telephone_number": "815-395-1500"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HOLDER",
        "first_name": "CANDICE",
        "middle_name": "J",
        "credential": "PMHNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2013-08-12",
        "last_updated": "2023-07-26",
        "certification_date": "2023-07-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "IL",
            "license": "209018392",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Rockford, IL

Sources for this page

Verify at the official NPI Registry.