Individual provider Active NPI

Thomas Ryan Hollifield, PA-C

  • Physician Assistant
  • Shelby, NC
National Provider Identifier
1487637047
Registry record updated May 17, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
103351 Issued in NC
Practice address
101 Delta Park Dr
Shelby, NC 28150-3575
Phone
(704) 323-2000
NPI assigned
Nov 28, 2005
Last updated
May 17, 2010By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 17, 2010

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 103351 NC Primary

Addresses

Primary practice location

101 Delta Park Dr
Shelby, NC 28150-3575

Mailing address

4061 Park Rd
Ste 300
Charlotte, NC 28209
Phone (704) 323-2000

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NC
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
I20050623000962 NC Practitioner - Physician Assistant 0042255655 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2001
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
OrthocarolinaGroup PAC ID 2062316821, 288 clinicians

Practice addresses (Care Compare)

101 Delta Park Dr
Shelby, NC 28150-3575
Phone (704) 484-0606

1915 Randolph Rd
Charlotte, NC 28207-1101
Phone (704) 323-2282

870 Summit Crossing PL
Gastonia, NC 28054-2192
Phone (704) 867-2333

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
94 of 100Reported as apm
Quality
81.63
Promoting interoperability
100
Improvement activities
40

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
103351NCMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Orthocarolina Physician Assistant CurrentSince Jan 18, 2005 Accepting new patients
Orthocarolina, PA Physician Assistant CurrentSince Jan 18, 2005 Accepting new patients
Orthocarolina Physician Assistant Past Accepting new patients

Locations

1001 Blythe Blvd
Ste 200
Charlotte, NC 28203
Phone (704) 373-0544

1915 Randolph Rd
Charlotte, NC 28207
Phone (704) 339-1000

4601 Park Rd
Ste 300
Charlotte, NC 28209
Phone (704) 323-2090

101 Delta Park Dr
Shelby, NC 28150
Phone (704) 323-2736

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.

Hospital & facility affiliations 1

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": "1133136000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1274054400000",
    "number": "1487637047",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4061 PARK RD",
            "address_2": "STE 300",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "28209",
            "telephone_number": "704-323-2000"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "101 DELTA PARK DR",
            "city": "SHELBY",
            "state": "NC",
            "postal_code": "281503575",
            "telephone_number": "704-323-2000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HOLLIFIELD",
        "first_name": "THOMAS",
        "middle_name": "RYAN",
        "name_prefix": "Mr.",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-11-28",
        "last_updated": "2010-05-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "NC",
            "license": "103351",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Shelby, NC

Sources for this page

Verify at the official NPI Registry.