Individual provider Active NPI

Shelly Welch Holmstrom, MD

  • Obstetrics & Gynecology Physician
  • Tampa, FL
National Provider Identifier
1427061043
Registry record updated Oct 25, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Obstetrics & Gynecology PhysicianTaxonomy code 207V00000X
License
ME90448 Issued in FL
Practice address
4503 N 22ND St
Tampa, FL 33610-6201
Phone
(813) 738-6684
Fax
(813) 413-8549
NPI assigned
Aug 14, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 25, 2023

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Obstetrics & Gynecology Physician 207V00000X ME90448 FL Primary

Addresses

Primary practice location

4503 N 22ND St
Tampa, FL 33610-6201

Mailing address

1410 Harbour Walk Rd
Tampa, FL 33602-5971
Phone (813) 394-1668

Other identifiers 2

IdentifierTypeStateIssuer
270375100MedicaidFL
48546OtherFLBLUE CROSS BLUE SHIELD

Medicare participation

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

Enrollment IDStateProvider typePAC IDDetails
I20040914000944 FL Practitioner - Obstetrics/Gynecology 1951378470 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Obstetrics/Gynecology
Education
University of Florida College of Medicine, 1998
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Florida Hospital Physician Group IncGroup PAC ID 2365679057, 953 clinicians

Practice addresses (Care Compare)

13901 Bruce B Downs Blvd
Tampa, FL 33613-3905
Phone (813) 615-7260

14710 Bruce B Downs Blvd
Tampa, FL 33613-2800
Phone (813) 738-6691

2700 Healing Way
Wesley Chapel, FL 33543-5453

3100 E Fletcher Ave
Tampa, FL 33613-4613
Phone (813) 615-7075

4503 N 22ND St
Tampa, FL 33610-6201
Phone (813) 738-6684

Hospital & facility affiliations

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Florida Hospital Physician Group Inc Obstetrics & Gynecology CurrentSince Oct 9, 2023 Accepting new patients
DHP of Manatee PA Obstetrics & Gynecology CurrentSince Apr 5, 2024 Accepting new patients

Locations

1500 SW 1st Ave
Ocala, FL 34471
Phone (352) 351-7500

703 N Flamingo Rd
Pembroke Pnes, FL 33028
Phone (954) 436-5000

4503 N 22nd St
Tampa, FL 33610
Phone (813) 738-6684

2701 W Mlk Blvd
Tampa, FL 33607
Phone (813) 738-6690

13601 Bruce B Downs Blvd
Ste 260
Tampa, FL 33613

14710 Bruce B Downs Blvd
Tampa, FL 33613
Phone (813) 738-6691

3100 E Fletcher Ave
Tampa, FL 33613
Phone (813) 615-7200

13901 Bruce B Downs Blvd
Tampa, FL 33613
Phone (813) 615-7260

2700 Healing Way
Ste 310
Wesley Chapel, FL 33543
Phone (813) 779-1209

101 Avenue O SE
Winter Haven, FL 33880
Phone (863) 294-7010

Networks

  • Optimum HealthCare HMO Network
  • Freedom Health HMO Network

Interoperability endpoints

  • Direct secure messaging: sholmstrom1941727@adventhealth.direct-ci.com

Organizations & group practices 2

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 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": "1155513600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1698192000000",
    "number": "1427061043",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1410 HARBOUR WALK RD",
            "city": "TAMPA",
            "state": "FL",
            "postal_code": "336025971",
            "telephone_number": "813-394-1668"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4503 N 22ND ST",
            "city": "TAMPA",
            "state": "FL",
            "postal_code": "336106201",
            "telephone_number": "813-738-6684",
            "fax_number": "813-413-8549"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HOLMSTROM",
        "first_name": "SHELLY",
        "middle_name": "WELCH",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-08-14",
        "last_updated": "2023-10-25",
        "certification_date": "2023-10-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207V00000X",
            "taxonomy_group": "",
            "desc": "Obstetrics & Gynecology",
            "state": "FL",
            "license": "ME90448",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "270375100",
            "state": "FL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD",
            "identifier": "48546",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Tampa, FL

Sources for this page

Verify at the official NPI Registry.