Active NPI
Charles Reed Holt, D.O.
- Emergency Medicine Physician
- Davenport, IA
National Provider Identifier
1477638005
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Emergency Medicine Physician
- License
- 02981
- Practice address
- 2026 N Main St
Davenport, IA 52803-2911 - Phone
- (515) 537-0326
- NPI assigned
- Oct 25, 2006
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Emergency Medicine Physician | 207P00000X | 02981 | IA | Primary |
| Emergency Medicine Physician | 207P00000X | 4350 | OK |
Addresses
Primary practice location
2026 N Main St
Davenport, IA 52803-2911
Mailing address
2026 N Main St
Davenport, IA 52803-2911
Phone (515) 537-0326
Other identifiers 3
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1477638005 | Medicaid | IA | |
| 6131490 | Medicaid | IA | |
| 1477638005 | Other | IA | BLUE SHIELD |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- HHS exclusion list flag
- Flagged The directory lists this NPI on an HHS exclusion list.
- Credentials
- Doctor of Osteopathy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 02981 | IA | MD | Emergency Medicine Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Trinity Medical Center | Emergency Medicine | Past | Accepting new patients |
| Cardiovascular Associates PC | Past | Accepting new patients | |
| Heritage Emergency Physicians | Emergency Medicine | Past | Accepting new patients |
| Stelzer Surgery, PC | Past | Accepting new patients | |
| Pioneer Plains Emergency Physicians | Emergency Medicine | Past | Accepting new patients |
Organizations & group practices 5
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.
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-
- General Practice Physician
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- NPI 1104977867
-
- Emergency Medicine Physician
- Guymon, OK
- NPI 1326266750
-
- Emergency Medicine Physician
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NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1161734400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1250208000000",
"number": "1477638005",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2026 N MAIN ST",
"city": "DAVENPORT",
"state": "IA",
"postal_code": "528032911",
"telephone_number": "515-537-0326"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2026 N MAIN ST",
"city": "DAVENPORT",
"state": "IA",
"postal_code": "528032911",
"telephone_number": "515-537-0326"
}
],
"practiceLocations": [],
"basic": {
"last_name": "HOLT",
"first_name": "CHARLES",
"middle_name": "REED",
"name_prefix": "Dr.",
"credential": "D.O.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2006-10-25",
"last_updated": "2009-08-14",
"status": "A"
},
"taxonomies": [
{
"code": "207P00000X",
"taxonomy_group": "",
"desc": "Emergency Medicine",
"state": "IA",
"license": "02981",
"primary": true
},
{
"code": "207P00000X",
"taxonomy_group": "",
"desc": "Emergency Medicine",
"state": "OK",
"license": "4350",
"primary": false
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "1477638005",
"state": "IA"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "6131490",
"state": "IA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BLUE SHIELD",
"identifier": "1477638005",
"state": "IA"
}
],
"endpoints": [],
"other_names": []
}
Other providers in Davenport, IA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 14, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.