Individual provider Active NPI

Brent Holland, D.C.

  • Chiropractor
  • Ardmore, OK
National Provider Identifier
1477830776
Registry record updated May 24, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
ChiropractorTaxonomy code 111N00000X
License
4052 Issued in OK
Practice address
1203 W Broadway St
Ardmore, OK 73401-2835
Phone
(580) 490-9888
Fax
(580) 490-9888
NPI assigned
Nov 15, 2011
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 24, 2019

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Chiropractor 111N00000X 4052 OK Primary

Addresses

Primary practice location

1203 W Broadway St
Ardmore, OK 73401-2835

Mailing address

1203 W Broadway St
Ardmore, OK 73401-2835
Phone (580) 490-9888

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OK

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20120607000676 OK Practitioner - Chiropractic 5395909154 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Chiropractic
Education
Other, 2011
Medicare assignment
Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

1203 W Broadway St
Ardmore, OK 73401-2835
Phone (580) 490-9888

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
4052OKMDPediatric Dentist

Practice roles

OrganizationSpecialtyStatusNew patients
Holland Health LLC Chiropractor CurrentSince Mar 6, 2012 Accepting new patients

Locations

1203 W Broadway St
Ardmore, OK 73401
Phone (580) 226-5858

Organizations & group practices 1

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.

NPI Registry JSON

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

{
    "created_epoch": "1321315200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1558656000000",
    "number": "1477830776",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1203 W BROADWAY ST",
            "city": "ARDMORE",
            "state": "OK",
            "postal_code": "734012835",
            "telephone_number": "580-490-9888",
            "fax_number": "580-490-9888"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1203 W BROADWAY ST",
            "city": "ARDMORE",
            "state": "OK",
            "postal_code": "734012835",
            "telephone_number": "580-490-9888",
            "fax_number": "580-490-9888"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HOLLAND",
        "first_name": "BRENT",
        "name_prefix": "Dr.",
        "credential": "D.C.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2011-11-15",
        "last_updated": "2019-05-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "",
            "desc": "Chiropractor",
            "state": "OK",
            "license": "4052",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Ardmore, OK

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 24, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.