Individual provider Active NPI

Shawn Holsonback, DO

  • Emergency Medicine Physician
  • Dalton, GA
National Provider Identifier
1396756680
Registry record updated Nov 14, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Emergency Medicine PhysicianTaxonomy code 207P00000X
License
045242 Issued in GA
Practice address
1200 Memorial Dr
Dalton, GA 30720-2529
Phone
(706) 272-6000
NPI assigned
Aug 11, 2006
Last updated
Nov 14, 2007By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 14, 2007

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Emergency Medicine Physician 207P00000X 045242 GA Primary

Addresses

Primary practice location

1200 Memorial Dr
Dalton, GA 30720-2529

Mailing address

PO Box 636019
Cincinnati, OH 45263-6019

Other identifiers 1

IdentifierTypeStateIssuer
P00255537OtherGARAILROAD MEDICARE

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TN, GA2 enrollments
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 2

Enrollment IDStateProvider typePAC IDDetails
I20040117000138 TN Practitioner - Emergency Medicine 2264333780 Reassigns benefits to 2 organizations
I20040903000318 GA Practitioner - Emergency Medicine 2264333780 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Emergency Medicine
Education
West Virginia School of Osteopathic Medicine, 1996
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Emergency Coverage LLCGroup PAC ID 3072412592, 761 clinicians

Practice addresses (Care Compare)

421 S Main St
Crossville, TN 38555-5031
Phone (931) 484-9511

Hospital & facility affiliations

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Emergency Coverage, LLC Emergency Medicine CurrentSince Mar 1, 2005 Accepting new patients
Emergency Medicine Services of TN, PC Emergency Medicine CurrentSince Apr 1, 2023 Accepting new patients
Emergency Coverage Services, PC Past Accepting new patients

Locations

1200 Memorial Dr
Dalton, GA 30720
Phone (706) 272-6115

100 Gross Crescent Cir
Ft Oglethorpe, GA 30742
Phone (706) 858-2301

7402 Lee Hwy
Chattanooga, TN 37421
Phone (423) 242-9750

421 S Main St
Crossville, TN 38555
Phone (931) 260-1465

7900 Rhea County Hwy
Dayton, TN 37321
Phone (423) 570-0018

1607 S Locust Ave
Lawrenceburg, TN 38464
Phone (731) 287-2244

2300 Patterson St
Nashville, TN 37203
Phone (615) 342-1500

Interoperability endpoints

  • Direct secure messaging: sholsonback18523@hhcs.direct-ci.com

Organizations & group practices 3

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 3

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": "1155254400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1194998400000",
    "number": "1396756680",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 636019",
            "city": "CINCINNATI",
            "state": "OH",
            "postal_code": "452636019"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1200 MEMORIAL DR",
            "city": "DALTON",
            "state": "GA",
            "postal_code": "307202529",
            "telephone_number": "706-272-6000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HOLSONBACK",
        "first_name": "SHAWN",
        "credential": "DO",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-08-11",
        "last_updated": "2007-11-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "GA",
            "license": "045242",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "P00255537",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Dalton, GA

Sources for this page

Verify at the official NPI Registry.