NPIMap

Organization Active NPI

Ortho Plus Holdings LLC

  • Sports Medicine (Orthopaedic Surgery) Physician
  • Oklahoma City, OK
National Provider Identifier
1548620529
Registry record updated Apr 25, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Sports Medicine (Orthopaedic Surgery) PhysicianTaxonomy code 207XX0005X
License
19051 Issued in OK
Legal business name
ORTHO PLUS HOLDINGS LLC
Practice address
12301 S Western Ave Ste A3
Oklahoma City, OK 73170-6085
Phone
(056) 768-6434
Fax
(405) 676-8644
NPI assigned
Mar 3, 2016
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 25, 2024

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

Authorized official

Name
Brent K HollimanNPI 1447297296
Title
Officer
Phone
(405) 285-2994

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Sports Medicine (Orthopaedic Surgery) PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207XX0005X 19051 OK Primary
Medical Specialty Clinic/Center 261QM2500X

Addresses

Primary practice location

12301 S Western Ave Ste A3
Oklahoma City, OK 73170-6085

Mailing address

301 Lilac Dr Ste 140
Edmond, OK 73034-7288

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20190104001810 OK Part B Supplier - Clinic/Group Practice 0345586822 Receives reassigned benefits from 11 practitioners
Practice locations: Oklahoma City, OK

Other NPIs with the same Medicare PAC ID 1

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

National Provider Directory

National Provider Directory

Locations

941 W I 35 Frontage Rd
Edmond, OK 73034
Phone (405) 227-9667

Practitioners & affiliated clinicians

Practitioners 14

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

View all 14

NPI Registry JSON

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

{
    "created_epoch": "1456963200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1714003200000",
    "number": "1548620529",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "301 LILAC DR STE 140",
            "city": "EDMOND",
            "state": "OK",
            "postal_code": "730347288"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12301 S WESTERN AVE STE A3",
            "city": "OKLAHOMA CITY",
            "state": "OK",
            "postal_code": "731706085",
            "telephone_number": "056-768-6434",
            "fax_number": "405-676-8644"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ORTHO PLUS HOLDINGS LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-03-03",
        "last_updated": "2024-04-25",
        "certification_date": "2024-04-25",
        "status": "A",
        "authorized_official_last_name": "HOLLIMAN",
        "authorized_official_first_name": "BRENT",
        "authorized_official_middle_name": "K",
        "authorized_official_title_or_position": "OFFICER",
        "authorized_official_telephone_number": "405-285-2994"
    },
    "taxonomies": [
        {
            "code": "207XX0005X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Orthopaedic Surgery, Sports Medicine",
            "state": "OK",
            "license": "19051",
            "primary": true
        },
        {
            "code": "261QM2500X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Medical Specialty",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Oklahoma City, OK

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 25, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.