NPIMap

Individual provider Active NPI

Theresa Clare Holland, N.P.

  • Nurse Practitioner
  • Jeffersonville, IN
National Provider Identifier
1578812160
Registry record updated Jul 25, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nurse PractitionerTaxonomy code 363L00000X
License
71004116 Issued in IN
Practice address
3118 E 10TH St
Suite B
Jeffersonville, IN 47130-5904
Phone
(812) 282-6979
Fax
(812) 282-6998
NPI assigned
Aug 29, 2012
Last updated
Jul 25, 2015By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 25, 2015

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Nurse Practitioner 363L00000X 71004116 IN Primary
Adult Health Nurse Practitioner 363LA2200X 71004116 IN
Registered Nurse 163W00000X 28108443A IN

Addresses

Primary practice location

3118 E 10TH St
Suite B
Jeffersonville, IN 47130-5904

Mailing address

PO Box 950202
Louisville, KY 40295-0202
Phone (502) 588-9490

Other identifiers 1

IdentifierTypeStateIssuer
201121090MedicaidIN

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IN
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20121112000729 IN Practitioner - Nurse Practitioner 3476704875 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2012
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Community Medical Associates IncGroup PAC ID 7012811284, 1,368 clinicians

Practice addresses (Care Compare)

11500 Hwy 62
Charlestown, IN 47111-8612
Phone (812) 256-0700

1373 E State Rd
Madison, IN 47250-7328

2021 Mercy Way
Suite 102
Jeffersonville, IN 47130-1307
Phone (812) 218-4630

2051 Clevidence Blvd
Clarksville, IN 47129-2278

4801 Paoli Pike
Suite 201
Floyds Knobs, IN 47119-9695
Phone (812) 923-4700

630 N Broadway St
Madison, IN 47250-7328
Phone (812) 801-0995

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
81.11 of 100Reported as group
Quality
63.34
Promoting interoperability
100
Improvement activities
40
Cost
73.68

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
28108443AINMDRegistered Nurse
71004116INMDNurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Community Medical Associates, Inc. Nurse Practitioner CurrentSince Aug 1, 2015 Accepting new patients
Community Medical Associates, Inc. Nurse Practitioner Current Accepting new patients
Community Medical Associates, Inc. Nurse Practitioner CurrentSince Aug 1, 2015 Accepting new patients
Louisville Geriatric Associates Nurse Practitioner Past Accepting new patients
Community Medical Associates, Inc. Nurse Practitioner Past Accepting new patients
Louisville Geriatric Associates Nurse Practitioner Past Accepting new patients

Locations

2051 Clevidence Blvd
Clarksville, IN 47129
Phone (812) 280-6650

3118 E 10th St
Ste A
Jeffersonville, IN 47130
Phone (812) 280-9355

3118 E 10th St
Ste B
Jeffersonvlle, IN 47130
Phone (812) 282-6979

1373 E State Road 62
#6F
Madison, IN 47250
Phone (502) 629-7181

Interoperability endpoints

  • FHIR API: https://api.platform.athenahealth.com/8360/brand/1/csg/1/fhir/r4
  • Direct secure messaging: tholland87424@direct.nortonhealthcare.org

Organizations & group practices 6

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 17

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

View all 17

NPI Registry JSON

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

{
    "created_epoch": "1346198400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1437782400000",
    "number": "1578812160",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 950202",
            "city": "LOUISVILLE",
            "state": "KY",
            "postal_code": "402950202",
            "telephone_number": "502-588-9490",
            "fax_number": "502-272-5116"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3118 E 10TH ST",
            "address_2": "SUITE B",
            "city": "JEFFERSONVILLE",
            "state": "IN",
            "postal_code": "471305904",
            "telephone_number": "812-282-6979",
            "fax_number": "812-282-6998"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HOLLAND",
        "first_name": "THERESA",
        "middle_name": "CLARE",
        "credential": "N.P.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2012-08-29",
        "last_updated": "2015-07-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "IN",
            "license": "71004116",
            "primary": true
        },
        {
            "code": "363LA2200X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Adult Health",
            "state": "IN",
            "license": "71004116",
            "primary": false
        },
        {
            "code": "163W00000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse",
            "state": "IN",
            "license": "28108443A",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "201121090",
            "state": "IN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Jeffersonville, IN

Sources for this page

Verify at the official NPI Registry.