Active NPI
Russell Scott Holliday, DO
- Emergency Medicine Physician
- Derby, CT
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Emergency Medicine Physician
- License
- 043634
- Practice address
- 130 Division St
Derby, CT 06418-1326 - Phone
- (203) 732-7403
- NPI assigned
- Mar 28, 2007
- Last updated
- Jul 8, 2007
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Emergency Medicine Physician | 207P00000X | 043634 | CT | Primary |
Addresses
Primary practice location
130 Division St
Derby, CT 06418-1326
Mailing address
130 Division St
Derby, CT 06418-1326
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in ID
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: Yes
Enrollment records 1
Care Compare profile
Medicare Care Compare- Specialty
- Emergency Medicine
- Education
- Kansas City University of Physicians and Surgeons, 2003
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
Practice addresses (Care Compare)
746 N College Rd
Twin Falls, ID 83301-3486
801 Pole Line Rd W
Twin Falls, ID 83301-5810
Hospital & facility affiliations
Merit-based Incentive Payment System (MIPS)
- Final score
- 85.09 of 100
- Quality
- 77.1
- Promoting interoperability
- 100
- Improvement activities
- 40
- Cost
- 73.19
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Osteopathy
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| St Luke's Clinic LLC | Current | Accepting new patients | |
| St Lukes Clinic - Wood River LLC | Emergency Medicine | Current | Accepting new patients |
| Arlington Urgent Care Inc | Past | Accepting new patients |
Locations
190 E Bannock St
Boise, ID 83712
Phone (208) 381-2378
709 N Lincoln Ave
Jerome, ID 83338
Phone (208) 324-4301
801 Pole Line Rd W
Twin Falls, ID 83301
Phone (208) 814-1000
746 N College Rd
Ste D
Twin Falls, ID 83301
Phone (208) 814-7230
Interoperability endpoints
- rholliday32771@direct.slhs.org
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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
-
dba St Lukes Clinic - Magic Valley/Jerome
- Family Medicine Physician
- Twin Falls, ID
- NPI 1790718229
-
- Internal Medicine Physician
- Ketchum, ID
- NPI 1972891604
Emergency Medicine
-
dba Arlington Urgent Care
- Urgent Care Clinic/Center
- Upper Arlington, OH
- NPI 1255624722
Hospital & facility affiliations 1
Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.
-
dba St Lukes Magic Valley - Air Ambulance
- General Acute Care Hospital
- Twin Falls, ID
- NPI 1932154705
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1175040000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1598884900",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "130 DIVISION ST",
"city": "DERBY",
"state": "CT",
"postal_code": "064181326"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "130 DIVISION ST",
"city": "DERBY",
"state": "CT",
"postal_code": "064181326",
"telephone_number": "203-732-7403"
}
],
"practiceLocations": [],
"basic": {
"last_name": "HOLLIDAY",
"first_name": "RUSSELL",
"middle_name": "SCOTT",
"credential": "DO",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2007-03-28",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "207P00000X",
"taxonomy_group": "",
"desc": "Emergency Medicine",
"state": "CT",
"license": "043634",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}
Other providers in Derby, CT
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- 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.