Individual provider Active NPI

Jennifer Ruth Fox Holohan, PA-C

  • Physician Assistant
  • Paso Robles, CA
National Provider Identifier
1467546150
Registry record updated Jun 29, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
PA17523 Issued in CA
Practice address
416 Spring Street
Suite 201
Paso Robles, CA 93446
Phone
(805) 226-1150
Fax
(805) 226-1195
NPI assigned
Oct 3, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 29, 2021

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 PA17523 CA Primary

Addresses

Primary practice location

416 Spring Street
Suite 201
Paso Robles, CA 93446

Mailing address

2050 S Blosser Rd
Santa Maria, CA 93458-7310
Phone (805) 361-8030

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20130208000344 CA Order and Referring Only - Physician Assistant 1658475074

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
17523CAMDMassage Therapist
PA17523CAMDPhysician Assistant

Interoperability endpoints

  • Direct secure messaging: jennifer.holohan.1@17363.direct.athenahealth.com

NPI Registry JSON

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

{
    "created_epoch": "1159833600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1624924800000",
    "number": "1467546150",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2050 S BLOSSER RD",
            "city": "SANTA MARIA",
            "state": "CA",
            "postal_code": "934587310",
            "telephone_number": "805-361-8030",
            "fax_number": "805-361-8097"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "416 SPRING STREET",
            "address_2": "SUITE 201",
            "city": "PASO ROBLES",
            "state": "CA",
            "postal_code": "93446",
            "telephone_number": "805-226-1150",
            "fax_number": "805-226-1195"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HOLOHAN",
        "first_name": "JENNIFER",
        "middle_name": "RUTH FOX",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-10-03",
        "last_updated": "2021-06-29",
        "certification_date": "2021-06-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "CA",
            "license": "PA17523",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Paso Robles, CA

Sources for this page

Verify at the official NPI Registry.