NPIMap

Individual provider Active NPI

Brent Keith Holliman, PA-C

  • Physician Assistant
  • Oklahoma City, OK
National Provider Identifier
1447297296
Registry record updated Aug 21, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
PA636 Issued in OK
Practice address
4345 W Memorial Rd
Suite 200
Oklahoma City, OK 73134-1702
Phone
(405) 936-5814
Fax
(405) 936-5810
NPI assigned
Jun 1, 2006
Last updated
Aug 21, 2013By the provider in NPPES
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Aug 21, 2013

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X PA636 OK Primary

Addresses

Primary practice location

4345 W Memorial Rd
Suite 200
Oklahoma City, OK 73134-1702

Mailing address

4345 W Memorial Rd
Suite 200
Oklahoma City, OK 73134-1702
Phone (405) 936-5814

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OK
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
I20050921000631 OK Practitioner - Physician Assistant 3274560669 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 1992
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Ortho Plus Holdings LLCGroup PAC ID 0345586822, 5 clinicians
Ortho Plus LLCGroup PAC ID 1052610524, 5 clinicians

Practice addresses (Care Compare)

12301 S Western Ave
Suite A3
Oklahoma City, OK 73170-6085
Phone (405) 676-8643

941 W I 35 Frontage Rd
Suite 164
Edmond, OK 73034-7375
Phone (405) 285-2994

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

State licenses

LicenseStateTypeSpecialty
636OKMDAddiction (Substance Use Disorder) Counselor
PA636OKMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Ortho Plus LLC CurrentSince Jan 26, 2016 Accepting new patients
Ortho Plus Holdings LLC CurrentSince Jan 1, 2019 Accepting new patients
Mercy Health Services Inc. Past Accepting new patients
Summit Medical Center Past Accepting new patients
Mercy Access LLC Past Accepting new patients
I Care Immediate Care LLC PastSince Jun 1, 2008 Accepting new patients
Deaconess Metropolitan Physicians LLC Physician Assistant Past Accepting new patients

Locations

2419 N Commerce St
Ste B
Ardmore, OK 73401
Phone (580) 226-7587

301 Lilac Dr
Ste 140
Edmond, OK 73034
Phone (405) 906-3755

941 W I 35 Frontage Rd
Ste 164
Edmond, OK 73034
Phone (405) 285-2994

12301 S Western Ave
Ste A3
Oklahoma City, OK 73170
Phone (405) 200-1869

Interoperability endpoints

  • Direct secure messaging: brent.holliman.1@13205.direct.athenahealth.com
  • Direct secure messaging: brent.holliman.1@18605.direct.athenahealth.com
  • FHIR API: https://api.platform.athenahealth.com/13205/brand/1/csg/1/fhir/r4

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 2

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": "1149120000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1377043200000",
    "number": "1447297296",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4345 W MEMORIAL RD",
            "address_2": "SUITE 200",
            "city": "OKLAHOMA CITY",
            "state": "OK",
            "postal_code": "731341702",
            "telephone_number": "405-936-5814",
            "fax_number": "405-936-5810"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4345 W MEMORIAL RD",
            "address_2": "SUITE 200",
            "city": "OKLAHOMA CITY",
            "state": "OK",
            "postal_code": "731341702",
            "telephone_number": "405-936-5814",
            "fax_number": "405-936-5810"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HOLLIMAN",
        "first_name": "BRENT",
        "middle_name": "KEITH",
        "credential": "PA-C",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-06-01",
        "last_updated": "2013-08-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "OK",
            "license": "PA636",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Oklahoma City, OK

Sources for this page

Verify at the official NPI Registry.