Mallory Holm, PA-C

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

PA9109182 Issued in FL

Practice address

1540 S Tamiami TRL
Suite 300
Sarasota, FL 34239-2930

Phone

(941) 917-8791

Fax

(941) 917-8793

NPI assigned

Jan 4, 2016

Last updated

Jan 4, 2016By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Eligible to order & refer

• Part B services: No
• Medical equipment: Yes
• Home health: No
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

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.

• SMH Physician Services Inc

  • Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician
  • Sarasota, FL
  • NPI 1477885747
  NPD (past)

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

{
    "created_epoch": "1451865600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1451865600000",
    "number": "1659737955",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 863407",
            "city": "ORLANDO",
            "state": "FL",
            "postal_code": "328863407",
            "telephone_number": "941-917-2600",
            "fax_number": "941-917-7884"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1540 S TAMIAMI TRL",
            "address_2": "SUITE 300",
            "city": "SARASOTA",
            "state": "FL",
            "postal_code": "342392930",
            "telephone_number": "941-917-8791",
            "fax_number": "941-917-8793"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HOLM",
        "first_name": "MALLORY",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2016-01-04",
        "last_updated": "2016-01-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "FL",
            "license": "PA9109182",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "33181",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Holli L Bodner Psy D P a
• Cheryl Ross Hollifield, CNM
• Kathryn Taylor Hollingsworth, ARNP
• Holly Gould Tucci
• Kari Holly, ARNP
• Christine Holmes-Bussey, LCSW
• Angela Holmes-Cruz, LMHC
• Concetta Hollinger Holmes, LCSW
• Linda Holmes, ARNP
• Michele Marie Holmes, LMT

• Physician Assistant in Sarasota, FL
• Providers in Sarasota, FL by specialty
• Physician Assistant in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 4, 2016; 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.