Individual provider Active NPI

Jennifer Dykes Holman, MD

  • Dermatology Physician
  • Tyler, TX
National Provider Identifier
1447354626
Registry record updated Aug 4, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Dermatology PhysicianTaxonomy code 207N00000X
License
M7274 Issued in TX
Practice address
1367 Dominion PLZ
Tyler, TX 75703-1013
Phone
(903) 534-6200
Fax
(903) 939-0755
NPI assigned
Sep 11, 2006
Last updated
Aug 4, 2017By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 4, 2017

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Dermatology Physician 207N00000X M7274 TX Primary

Addresses

Primary practice location

1367 Dominion PLZ
Tyler, TX 75703-1013

Mailing address

1367 Dominion PLZ
Tyler, TX 75703-1013
Phone (903) 534-6200

Other names 1

  • Jennifer Christian Dykes Former name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TX
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
I20080328000529 TX Practitioner - DermatologyPractitioner - Micrographic Dermatologic Surgery (MDS) 1355427485 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
DermatologyAlso: Micrographic Dermatologic Surgery (MDS)
Education
University of Oklahoma College of Medicine, 2004
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Oliver Street 5.01(a) IncGroup PAC ID 0042464125, 169 clinicians

Practice addresses (Care Compare)

8210 Walnut Hill LN
Suite 810
Dallas, TX 75231-4421
Phone (214) 369-6411

Merit-based Incentive Payment System (MIPS)

Final score
100 of 100Reported as individual
Promoting interoperability
100
Improvement activities
40

Procedures performed for Medicare patients

ProcedureNumber of procedures
Melanoma (skin cancer) excision647
Removal of skin lesions2266
Removal of skin cancer769
Removal of nail tissue1-10
Removal or shaving of skin growth73
Skin biopsy323

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Oliver Street 5.01(a) Inc. Dermatology CurrentSince Dec 15, 2012 Accepting new patients
Advanced Dermatologic Surgery PA Dermatology CurrentSince Jul 31, 2020 Accepting new patients
Dermatology Associates Dermatology Past Accepting new patients
Lawrence L Anderson MD PA Dermatology Past Accepting new patients

Locations

5310 Harvest Hill Rd
Ste 290
Dallas, TX 75230
Phone (214) 420-0672

6117 Berkshire Ln
Dallas, TX 75225
Phone (214) 373-3376

8210 Walnut Hill Ln
Ste 810
Dallas, TX 75231
Phone (214) 363-1885

1213 Hermann Dr
Ste 650
Houston, TX 77004
Phone (713) 528-8882

3611 North St
Ste 140
Nacogdoches, TX 75965
Phone (936) 260-7801

1367 Dominion Plz
Tyler, TX 75703
Phone (903) 534-6200

1720 S Beckham Ave
Ste 102
Tyler, TX 75701
Phone (903) 534-6200

4809 Old Bullard Rd
Tyler, TX 75703
Phone (903) 534-6200

4809 Old Bullard Rd
Ste 500
Tyler, TX 75703
Phone (903) 579-7261

Interoperability endpoints

  • FHIR API: https://fhir.nextgen.com/nge/prod/fhir-api-r4/fhir/r4/

Organizations & group practices 4

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.

NPI Registry JSON

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

{
    "created_epoch": "1157932800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1501804800000",
    "number": "1447354626",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1367 DOMINION PLZ",
            "city": "TYLER",
            "state": "TX",
            "postal_code": "757031013",
            "telephone_number": "903-534-6200",
            "fax_number": "903-939-0755"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1367 DOMINION PLZ",
            "city": "TYLER",
            "state": "TX",
            "postal_code": "757031013",
            "telephone_number": "903-534-6200",
            "fax_number": "903-939-0755"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HOLMAN",
        "first_name": "JENNIFER",
        "middle_name": "DYKES",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-09-11",
        "last_updated": "2017-08-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207N00000X",
            "taxonomy_group": "",
            "desc": "Dermatology",
            "state": "TX",
            "license": "M7274",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "JENNIFER",
            "last_name": "DYKES",
            "middle_name": "CHRISTIAN",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Tyler, TX

Sources for this page

Verify at the official NPI Registry.