Bradly Shane Holland, DO

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

E-5111 Issued in AR

Practice address

5208 W Village Pkwy Ste 1
Rogers, AR 72758-8199

Phone

(479) 389-2803

NPI assigned

Jun 29, 2006

Last updated

Jul 31, 2024By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 3

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Enrolled in AR

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Osteopathy

State licenses

Practice roles

Locations

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.

• HCC of Magnolia LLC

  • Hospitalist Physician
  • Magnolia, AR
  • NPI 1831865872
  Medicare reassignment NPD
• Sgoh Acquisition Inc

  dba Ozarks Community Hospital of Gravette

  • Critical Access Hospital
  • Gravette, AR
  • NPI 1568643005
  Medicare reassignment NPD
• South Arkansas Emergency Physicians LLP

  • Emergency Medicine Physician
  • El Dorado, AR
  • NPI 1942435458
  Medicare reassignment NPD
• Emergency Staffing Solutions Region III

  • Emergency Medicine Physician
  • Dallas, TX
  • NPI 1689967895

  AR

  Medicare reassignment NPD
• Southeastern Emergency Physicians LLC

  • Emergency Medicine Physician
  • Maysville, KY
  • NPI 1356379382

  AR

  Medicare reassignment NPD
• B Shane Holland, DO, PLLC

  dba Holland Health: A Functional Medicine Clinic

  • Clinic/Center
  • Rogers, AR
  • NPI 1659199388
  NPD Authorized official
• Sgoh Acquisition Inc

  dba Och Decatur Clinic

  • Rural Health Clinic/Center
  • Decatur, AR
  • NPI 1699513507
  NPD
• South Arkansas Emergency Physicians, LLP

  • Emergency Medicine Physician
  • Siloam Springs, AR
  • NPI 1225452055
  NPD
• Bentonville Radiology Consultants, PLLC

  • Diagnostic Radiology Physician
  • Bentonville, AR
  • NPI 1003882747
  NPD (past)
• Emmaus Community Healthcare, PLLC

  dba DBA: Piney Flats Urgent Care

  • General Practice Physician
  • Piney Flats, TN
  • NPI 1356379093
  NPD (past)
• Occupational Alternative and Rehabilitative Services, PC

  • Physical Medicine & Rehabilitation Physician
  • Chattanooga, TN
  • NPI 1487743449
  NPD (past)
• Southern Rehabilitation Group, PLLC

  • Physical Medicine & Rehabilitation Physician
  • Chattanooga, TN
  • NPI 1609965656
  NPD (past)

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

{
    "created_epoch": "1151539200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1722384000000",
    "number": "1619905692",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4310 W WOODVIEW",
            "city": "ROGERS",
            "state": "AR",
            "postal_code": "727588084",
            "telephone_number": "479-586-0984"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5208 W VILLAGE PKWY STE 1",
            "city": "ROGERS",
            "state": "AR",
            "postal_code": "727588199",
            "telephone_number": "479-389-2803"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1101 Jackson St SW",
            "address_purpose": "LOCATION",
            "city": "Gravette",
            "state": "AR",
            "postal_code": "727369121",
            "country_code": "US",
            "telephone_number": "479-787-5291",
            "fax_number": "479-344-6404",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1519 Main St",
            "address_purpose": "LOCATION",
            "city": "Sneedville",
            "state": "TN",
            "postal_code": "378693657",
            "country_code": "US",
            "telephone_number": "423-733-5022",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "HOLLAND",
        "first_name": "BRADLY",
        "middle_name": "SHANE",
        "name_prefix": "Dr.",
        "credential": "DO",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-06-29",
        "last_updated": "2024-07-31",
        "certification_date": "2024-07-31",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "AR",
            "license": "E5111",
            "primary": false
        },
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "TN",
            "license": "1639",
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "AR",
            "license": "E-5111",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "3300823",
            "state": "TN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS OF TN",
            "identifier": "4119511",
            "state": "TN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Keleigh Hodges
• Charles William Hof, M.D.
• Hannah M Hoffman, CRNA
• Gianna Hogan
• Malindi Holder
• John Wilson Holland Jr., D.D.S.
• April Holliday, LAC
• Dane L Hollis, D.D.S.
• Caroline Elise Holloway, PT, DPT
• Ginger Leann Holloway, APRN

• Family Medicine Physician in Rogers, AR
• Providers in Rogers, AR by specialty
• Family Medicine Physician in Arkansas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 31, 2024; 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.