John Robert Holttum, MD

Primary specialty

Child & Adolescent Psychiatry PhysicianTaxonomy code 2084P0804X

License

MD00031823 Issued in WA

Practice address

324 W Bay Dr NW
Suite 214a
Olympia, WA 98502-4926

Phone

(360) 464-9110

Fax

(360) 350-5610

NPI assigned

May 18, 2006

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

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.

Opted out of Medicare

Yes, effective Nov 30, 2017 through Nov 30, 2027

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

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.

• Behavioral Health Resources

  • Community/Behavioral Health Agency
  • Elma, WA
  • NPI 1306918750
  NPD (past)
• Vest Thurston LLC

  dba South Sound Behavioral Hospital

  • Psychiatric Hospital
  • Lacey, WA
  • NPI 1336605849
  NPD (past)

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

{
    "created_epoch": "1147910400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1442966400000",
    "number": "1700839891",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "324 W BAY DR NW",
            "address_2": "SUITE 214A",
            "city": "OLYMPIA",
            "state": "WA",
            "postal_code": "985024926",
            "telephone_number": "360-464-9110",
            "fax_number": "360-350-5610"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "324 W BAY DR NW",
            "address_2": "SUITE 214A",
            "city": "OLYMPIA",
            "state": "WA",
            "postal_code": "985024926",
            "telephone_number": "360-464-9110",
            "fax_number": "360-350-5610"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HOLTTUM",
        "first_name": "JOHN",
        "middle_name": "ROBERT",
        "name_prefix": "Mr.",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-05-18",
        "last_updated": "2015-09-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2084P0804X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Child & Adolescent Psychiatry",
            "state": "WA",
            "license": "MD00031823",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Shawn Holmes, LMT
• Janice Holt
• Johnny Lee Holt
• Sabrina Holt, LPN
• Catharina Holtsberry
• Nancy Amelia Holzinger, ARNP
• Stephanie Honshell
• Charlene Mae Hood, PHYSICAL THERAPIST
• Kristin Kay Hood, DPT
• Michelle Jennings Hood

• Child & Adolescent Psychiatry Physician in Olympia, WA
• Providers in Olympia, WA by specialty
• Child & Adolescent Psychiatry Physician in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 23, 2015; 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; Opt Out Affidavits.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.