NPIMap

Individual provider Active NPI

Kenneth L Holling, MD

  • Pulmonary Disease Physician
  • Stuart, FL
National Provider Identifier
1396737516
Registry record updated Apr 1, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pulmonary Disease PhysicianTaxonomy code 207RP1001X
License
ME0054425 Issued in FL
Practice address
2628 SE Willoughby Blvd
Stuart, FL 34994-4700
Phone
(772) 215-4562
NPI assigned
Aug 16, 2005
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 1, 2025

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X ME0054425 FL
Pulmonary Disease Physician 207RP1001X ME0054425 FL Primary

Addresses

Primary practice location

2628 SE Willoughby Blvd
Stuart, FL 34994-4700

Mailing address

565 SE Ashley Oaks Way
Stuart, FL 34997-2810
Phone (772) 215-4562

Other practice location 1

200 SE Hospital Ave
Stuart, FL 34994-2346
Phone (772) 223-5618

Other identifiers 2

IdentifierTypeStateIssuer
18604OtherFLFL BLUE
013390900MedicaidFL

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20100909001259 FL Practitioner - Pulmonary DiseasePractitioner - Internal MedicinePractitioner - Critical Care (Intensivists) 5496870719 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Pulmonary DiseaseAlso: Critical Care (Intensivists), Internal Medicine
Education
University of South Florida College of Medicine, 1990
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services

Practice addresses (Care Compare)

2628 SE Willoughby Blvd
Stuart, FL 34994-4700

3515 SE Willoughby Blvd
Stuart, FL 34994-5059
Phone (772) 215-4562

Hospital & facility affiliations

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Associates of Pulmonary Medicine LLC Pulmonary Disease PastSince Apr 5, 2020 Accepting new patients
Coastal Care Corporation Past Accepting new patients
Martin Memorial Medical Center Inc Past Accepting new patients
Center for Cranial/Spinal Surgery Past Accepting new patients
Coastal Care Corporation Past Accepting new patients
Coastal Care Corporation Past Accepting new patients
Coastal Care Corporation Past Accepting new patients
Mobile Medical Associates, P.L. Pulmonary Disease PastSince Aug 10, 2016 Accepting new patients

Organizations & group practices 9

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.

Hospital & facility affiliations 6

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": "1124150400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1743465600000",
    "number": "1396737516",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "565 SE ASHLEY OAKS WAY",
            "city": "STUART",
            "state": "FL",
            "postal_code": "349972810",
            "telephone_number": "772-215-4562"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2628 SE WILLOUGHBY BLVD",
            "city": "STUART",
            "state": "FL",
            "postal_code": "349944700",
            "telephone_number": "772-215-4562"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "200 SE Hospital Ave",
            "address_purpose": "LOCATION",
            "city": "Stuart",
            "state": "FL",
            "postal_code": "349942346",
            "country_code": "US",
            "telephone_number": "772-223-5618",
            "fax_number": "772-288-5834",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "HOLLING",
        "first_name": "KENNETH",
        "middle_name": "L",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-08-16",
        "last_updated": "2025-04-01",
        "certification_date": "2025-04-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "FL",
            "license": "ME0054425",
            "primary": false
        },
        {
            "code": "207RP1001X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Pulmonary Disease",
            "state": "FL",
            "license": "ME0054425",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "FL BLUE",
            "identifier": "18604",
            "state": "FL"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "013390900",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Stuart, FL

Sources for this page

Verify at the official NPI Registry.