Todd Jeramie Holter, PAC

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

9820 Issued in MN

Practice address

155 Radio Dr
Woodbury, MN 55125-2619

Phone

(952) 831-8742

Fax

(952) 977-3459

NPI assigned

Jun 30, 2005

Sex

Male

Sole proprietor

No

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

Specialties & licenses 3

Addresses

Medicare fee-for-service enrollment

Enrolled in WI, MN2 enrollments

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 2

Specialty

Physician Assistant

Education

Other, 2003

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Tria Orthopaedic Center LLCGroup PAC ID 3173570561, 504 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Lakeview Memorial Hospital Hospital, Stillwater, MN, CCN 240066
• Hudson Hospital Hospital, Hudson, WI, CCN 521335
• Amery Hospital & Clinic Hospital, Amery, WI, CCN 521308

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: tholter52492@direct.healthpartners.com

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.

• Tria Orthopaedic Center LLC

  dba TRIA Orthopaedic Clinic

  • Orthopaedic Surgery Physician
  • Bloomington, MN
  • NPI 1518273085

  WI

  Medicare reassignment Care Compare group NPD
• Infinite Health Collaborative, PA

  • Orthopaedic Surgery Physician
  • Bloomington, MN
  • NPI 1164474250

  WI

  Medicare reassignment
• Tria Orthopaedic Center LLC

  • Orthopaedic Surgery Physician
  • Bloomington, MN
  • NPI 1346624384
  NPD
• Infinite Health Collaborative, PA

  • Durable Medical Equipment & Medical Supplies
  • River Falls, WI
  • NPI 1144608589
  NPD (past)

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

• Lakeview Memorial Hospital Association Inc

  dba Lakeview Hospital

  • General Acute Care Hospital
  • Stillwater, MN
  • NPI 1538138003
  Care Compare affiliation
• Lakeview Memorial Hospital Association Inc

  • Land Ambulance
  • Stillwater, MN
  • NPI 1730213653

  Hospital

  Care Compare affiliation
• Amery Regional Medical Center, Inc.

  dba Amery Hospital & Clinic

  • Critical Access Hospital
  • Amery, WI
  • NPI 1093763518
  Care Compare affiliation
• Amery Regional Medical Center, Inc.

  dba Amery Hospital & Clinic -Clear Lake Clinic

  • Rural Health Clinic/Center
  • Clear Lake, WI
  • NPI 1366878449

  Hospital

  Care Compare affiliation
• Amery Regional Medical Center, Inc.

  dba Turtle Lake Clinic

  • Rural Health Clinic/Center
  • Turtle Lake, WI
  • NPI 1538384466

  Hospital

  Care Compare affiliation
• Amery Regional Medical Center, Inc.

  dba Amery Hospital & Clinic - Luck

  • Rural Health Clinic/Center
  • Luck, WI
  • NPI 1851345268

  Hospital

  Care Compare affiliation
• Hudson Hospital, Inc.

  dba Hudson Hospital & Clinics

  • Critical Access Hospital
  • Hudson, WI
  • NPI 1396849303
  Care Compare affiliation

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

{
    "created_epoch": "1120089600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1688083200000",
    "number": "1396742896",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8170 33RD AVE S # MS 21110Q",
            "city": "BLOOMINGTON",
            "state": "MN",
            "postal_code": "554254516"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "155 RADIO DR",
            "city": "WOODBURY",
            "state": "MN",
            "postal_code": "551252619",
            "telephone_number": "952-831-8742",
            "fax_number": "952-977-3459"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "5803 Neal Ave N",
            "address_purpose": "LOCATION",
            "city": "Oak Park Heights",
            "state": "MN",
            "postal_code": "550822177",
            "country_code": "US",
            "telephone_number": "651-439-8807",
            "fax_number": "651-439-0232",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "HOLTER",
        "first_name": "TODD",
        "middle_name": "JERAMIE",
        "credential": "PAC",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-06-30",
        "last_updated": "2023-06-30",
        "certification_date": "2023-06-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AS0400X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Surgical",
            "state": "WI",
            "license": "1684",
            "primary": false
        },
        {
            "code": "363AS0400X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Surgical",
            "state": "MN",
            "license": "9820",
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "MN",
            "license": "9820",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Mark E Holm, MD
• Jacquelyn Elizabeth Holman
• Kristen Marie Holmen, MPT
• Sarah Marie Holmgren, CNM
• Amy Holmstadt
• Lisa Jo Holtman
• Christin Holy, LICSW
• Hong Fu Home Health Care
• Linn Honken, LPC, LPCC
• Hope Village, LLC

• Physician Assistant in Woodbury, MN
• Providers in Woodbury, MN by specialty
• Physician Assistant in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 30, 2023; 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.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.