Individual provider Active NPI

Garrett John Holubeck

  • Speech-Language Pathologist
  • Adrian, MI
National Provider Identifier
1538740360
Registry record updated Apr 16, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Speech-Language PathologistTaxonomy code 235Z00000X
License
1538740360 Issued in MI
Practice address
200 Sand Creek Hwy
Adrian, MI 49221-1255
Phone
(517) 263-6794
NPI assigned
Apr 14, 2021
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 16, 2021

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Speech-Language Pathologist 235Z00000X 1538740360 MI Primary

Addresses

Primary practice location

200 Sand Creek Hwy
Adrian, MI 49221-1255

Mailing address

830 4TH St Apt 8
Bowling Green, OH 43402-4134
Phone (740) 310-3639

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)
Enrolled

State licenses

LicenseStateTypeSpecialty
1538740360MIMDSpeech-Language Pathologist

Practice roles

OrganizationSpecialtyStatusNew patients
Aegis Group Practice LLC Speech-Language Pathologist CurrentSince Mar 1, 2023 Accepting new patients
Aegis Group Practice LLC Speech-Language Pathologist CurrentSince Mar 1, 2023 Accepting new patients
Aegis Group Practice LLC Speech-Language Pathologist Current Accepting new patients

Locations

4933 Old Greenwood Rd
Fort Smith, AR 72903

7515 Secor Rd
Lambertville, MI 48144
Phone (419) 893-9230

Organizations & group practices 3

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": "1618358400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1618531200000",
    "number": "1538740360",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "830 4TH ST APT 8",
            "city": "BOWLING GREEN",
            "state": "OH",
            "postal_code": "434024134",
            "telephone_number": "740-310-3639"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "200 SAND CREEK HWY",
            "city": "ADRIAN",
            "state": "MI",
            "postal_code": "492211255",
            "telephone_number": "517-263-6794"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HOLUBECK",
        "first_name": "GARRETT",
        "middle_name": "JOHN",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2021-04-14",
        "last_updated": "2021-04-16",
        "certification_date": "2021-04-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "235Z00000X",
            "taxonomy_group": "",
            "desc": "Speech-Language Pathologist",
            "state": "MI",
            "license": "1538740360",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Adrian, MI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 16, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.