Individual provider Active NPI

Hollie A Green, AGAC-NP-BC

  • Acute Care Nurse Practitioner
  • Mount Clemens, MI
National Provider Identifier
1669038741
Registry record updated Oct 31, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Acute Care Nurse PractitionerTaxonomy code 363LA2100X
License
4704229157 Issued in MI
Practice address
1000 Harrington St
Mount Clemens, MI 48043-2920
Phone
(810) 241-8857
NPI assigned
May 14, 2019
Last updated
Oct 31, 2019By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 31, 2019

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Acute Care Nurse Practitioner 363LA2100X 4704229157 MI Primary

Addresses

Primary practice location

1000 Harrington St
Mount Clemens, MI 48043-2920

Mailing address

401 S Ballenger Hwy
Flint, MI 48532-3638
Phone (810) 342-5700

Other names 1

  • Mrs. Hollie Ann Racely Former name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MI
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20191112002692 MI Practitioner - Nurse Practitioner 7012349079 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2019
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
McLaren FlintGroup PAC ID 8628975497, 144 clinicians

Practice addresses (Care Compare)

401 S Ballenger Hwy
Flint, MI 48532-3638
Phone (810) 342-2063

Hospital & facility affiliations

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
McLaren Flint Nurse Practitioner CurrentSince Oct 1, 2019 Accepting new patients
McLaren Flint CurrentSince Oct 1, 2019 Accepting new patients
McLaren Flint Current Accepting new patients
McLaren Flint Past Accepting new patients

Locations

401 S Ballenger Hwy
Flint, MI 48532
Phone (810) 342-1000

401 S Ballenger Hwy
Ste 3N
Flint, MI 48532
Phone (810) 342-5700

Organizations & group practices 4

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 1

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

NPI Registry JSON

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

{
    "created_epoch": "1557792000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1572480000000",
    "number": "1669038741",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "401 S BALLENGER HWY",
            "city": "FLINT",
            "state": "MI",
            "postal_code": "485323638",
            "telephone_number": "810-342-5700",
            "fax_number": "810-342-5545"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1000 HARRINGTON ST",
            "city": "MOUNT CLEMENS",
            "state": "MI",
            "postal_code": "480432920",
            "telephone_number": "810-241-8857"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GREEN",
        "first_name": "HOLLIE",
        "middle_name": "A",
        "name_prefix": "Mrs.",
        "credential": "AGAC-NP-BC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2019-05-14",
        "last_updated": "2019-10-31",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LA2100X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Acute Care",
            "state": "MI",
            "license": "4704229157",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "HOLLIE",
            "last_name": "RACELY",
            "middle_name": "ANN",
            "prefix": "MRS.",
            "credential": "RN, AGACNP-BC",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Mount Clemens, MI

Sources for this page

Verify at the official NPI Registry.