Individual provider Active NPI

Holly Rebecca Harrison, PA-C

  • Physician Assistant
  • Columbia, MO
National Provider Identifier
1710638218
Registry record updated Jun 15, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
2022003496 Issued in MO
Practice address
405 E Nifong Blvd
Columbia, MO 65201-3708
Phone
(573) 884-0146
Fax
(573) 884-1066
NPI assigned
Jan 16, 2022
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 15, 2022

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X 1172455 MO
Physician Assistant 363A00000X 2022003496 MO Primary

Addresses

Primary practice location

405 E Nifong Blvd
Columbia, MO 65201-3708

Mailing address

PO Box 843966
Kansas City, MO 64184-3966
Phone (573) 884-3300

Other identifiers 1

IdentifierTypeStateIssuer
220108653MedicaidMO

Other names 1

  • Holly Rebecca Reese Former name

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address MUDOCREFERRAL@direct.health.missouri.edu Direct Curators of the University of Missouri

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MO
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
I20220606001352 MO Practitioner - Physician Assistant 2860870763 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2021
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

1 Hospital Dr
Columbia, MO 65212-0001
Phone (573) 882-2100

1020 Hitt St
Columbia, MO 65212-0001

1100 Virginia Ave
Columbia, MO 65212-0001
Phone (573) 882-2667

25 Conley Rd
Columbia, MO 65201-6477
Phone (573) 884-0169

3100 W Broadway
Mizzou Quick Care Broadway
Columbia, MO 65203-0102
Phone (573) 884-0036

405 E Nifong Blvd
Mizzou Quick Care Nifong
Columbia, MO 65201-3708
Phone (573) 884-0146

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
80.23 of 100Reported as group
Quality
58.17
Promoting interoperability
100
Improvement activities
40
Cost
75.92

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

State licenses

LicenseStateTypeSpecialty
1172455MOMDPhysician Assistant
2022003496MOMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Curators of the University of Missouri CurrentSince May 19, 2022 Accepting new patients

Locations

405 E Nifong Blvd
Columbia, MO 65201
Phone (573) 442-8595

1 Hospital Dr
Columbia, MO 65212
Phone (573) 882-2568

Organizations & group practices 2

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.

Hospital & facility affiliations 2

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": "1642291200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1655251200000",
    "number": "1710638218",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 843966",
            "city": "KANSAS CITY",
            "state": "MO",
            "postal_code": "641843966",
            "telephone_number": "573-884-3300",
            "fax_number": "573-884-0943"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "405 E NIFONG BLVD",
            "city": "COLUMBIA",
            "state": "MO",
            "postal_code": "652013708",
            "telephone_number": "573-884-0146",
            "fax_number": "573-884-1066"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HARRISON",
        "first_name": "HOLLY",
        "middle_name": "REBECCA",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2022-01-16",
        "last_updated": "2022-06-15",
        "certification_date": "2022-03-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "MO",
            "license": "1172455",
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "MO",
            "license": "2022003496",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "220108653",
            "state": "MO"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "MUDOCREFERRAL@direct.health.missouri.edu",
            "affiliation": "Y",
            "endpointDescription": "Endpoint is used to receive electronic continuity of care documents (C-CDA) for outpatient referrals.",
            "affiliationName": "Curators of the University of Missouri",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "Direct",
            "address_1": "405 E Nifong Blvd",
            "city": "Columbia",
            "state": "MO",
            "country_code": "US",
            "postal_code": "652013708",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "first_name": "HOLLY",
            "last_name": "REESE",
            "middle_name": "REBECCA",
            "credential": "PA-C",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Columbia, MO

Sources for this page

Verify at the official NPI Registry.