Active NPI
Holm Medical Clinic Inc
- Family Medicine Physician
- Plymouth, IN
National Provider Identifier
1427799535
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Medicine Physician
- Legal business name
- HOLM MEDICAL CLINIC INC
- Practice address
- 2855 Miller Dr Ste 205
Plymouth, IN 46563-8093 - Phone
- (574) 286-0200
- NPI assigned
- Apr 5, 2022
- Organization subpart
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Byron M Holm, MD
- Title
- President
- Phone
- (574) 286-0200
Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | Primary |
Addresses
Primary practice location
2855 Miller Dr Ste 205
Plymouth, IN 46563-8093
Mailing address
2855 Miller Drive, Ste 205
Plymouth, IN 46563-8093
Phone (574) 780-3312
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in IN
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20220419001409 | IN | Part B Supplier - Clinic/Group Practice | 8022405208 |
Receives reassigned benefits from 3 practitioners Practice locations: Plymouth, IN |
National Provider Directory
National Provider DirectoryLocations
1410 Deer Run Dr
Mishawaka, IN 46545
Phone (833) 944-1377
2560 Lake Ave
Plymouth, IN 46563
Practitioners & affiliated clinicians
Practitioners 3
Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1649116800000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1651536000000",
"number": "1427799535",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2855 MILLER DRIVE, STE 205",
"city": "PLYMOUTH",
"state": "IN",
"postal_code": "465638093",
"telephone_number": "574-780-3312",
"fax_number": "888-247-3121"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2855 MILLER DR STE 205",
"city": "PLYMOUTH",
"state": "IN",
"postal_code": "465638093",
"telephone_number": "574-286-0200"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "HOLM MEDICAL CLINIC INC",
"organizational_subpart": "NO",
"enumeration_date": "2022-04-05",
"last_updated": "2022-05-03",
"certification_date": "2022-05-03",
"status": "A",
"authorized_official_last_name": "HOLM",
"authorized_official_first_name": "BYRON",
"authorized_official_middle_name": "M",
"authorized_official_title_or_position": "PRESIDENT",
"authorized_official_telephone_number": "574-286-0200",
"authorized_official_credential": "MD"
},
"taxonomies": [
{
"code": "207Q00000X",
"taxonomy_group": "193400000X SINGLE SPECIALTY GROUP",
"desc": "Family Medicine",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Plymouth, IN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 3, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.