Brett Holdaway, DO

Primary specialty

Pediatrics PhysicianTaxonomy code 208000000X

License

009073 Issued in AZ

Practice address

4540 E Baseline Rd Ste 108
Mesa, AZ 85206-4616

Phone

(480) 892-3880

NPI assigned

May 5, 2018

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in NY

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

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Gilbert Childrens Medical Group Inc

  • Pediatrics Physician
  • Mesa, AZ
  • NPI 1427211804

  Pediatrics

  NPD (past)

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

{
    "created_epoch": "1525478400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1623888000000",
    "number": "1700375763",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4540 E BASELINE RD STE 108",
            "city": "MESA",
            "state": "AZ",
            "postal_code": "852064616"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4540 E BASELINE RD STE 108",
            "city": "MESA",
            "state": "AZ",
            "postal_code": "852064616",
            "telephone_number": "480-892-3880"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HOLDAWAY",
        "first_name": "BRETT",
        "credential": "DO",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2018-05-05",
        "last_updated": "2021-06-17",
        "certification_date": "2021-06-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "AZ",
            "license": "009073",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Charlene A Hogle, D.C.
• Frank Matthew Hogle, D.C.
• Kerri Hohn
• Brittany Lynn Hokin
• Alisha Kristine Holben, PMHNP-BC
• William E Holder, FNP-C
• Roy Holexa, DDS
• Terry Ann Holiday
• Holistic Medical Group
• Holistic Wellness Alliance, LLC

• All providers in Mesa, AZ
• Pediatrics Physician in Arizona

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 17, 2021; 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.