Mark Irvin Holub, MD

Primary specialty

Psychiatry PhysicianTaxonomy code 2084P0800X

License

33545 Issued in MN

Practice address

1406 6TH Ave N
St Cloud, MN 56303

Phone

(320) 251-2700

Fax

(320) 656-7026

NPI assigned

May 11, 2006

Sex

Male

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

Enrolled in MN

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 Medicine

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: mholub1333@direct.centracare.com

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.

• Centracare Health System-NR LLC

  dba CentraCare Health - Monticello Hospital

  • Critical Access Hospital
  • Monticello, MN
  • NPI 1275872772
  Medicare reassignment NPD
• Centracare Health System-NR LLC

  dba CentraCare - Monticello Specialty Clinic

  • Multi-Specialty Clinic/Center
  • Monticello, MN
  • NPI 1558600874
  Medicare reassignment NPD
• St. Cloud Hospital

  • General Acute Care Hospital
  • Saint Cloud, MN
  • NPI 1043269798
  Medicare reassignment NPD
• Centracare Health System-NR LLC

  dba Geriatric Behavioral Health

  • Psychiatric Hospital Unit
  • Monticello, MN
  • NPI 1003353202
  NPD
• Regents of the University of Minnesota

  dba Boynton Health Service

  • Student Health Clinic/Center
  • Minneapolis, MN
  • NPI 1013137355
  NPD
• Regents of the University of Minnesota

  dba Community-University Health Care Center

  • Federally Qualified Health Center (FQHC)
  • Minneapolis, MN
  • NPI 1114019858
  NPD
• Regents of the University of Minnesota

  dba Boynton Health Service

  • Clinic Pharmacy
  • Minneapolis, MN
  • NPI 1528288875
  NPD
• St. Cloud Hospital

  dba Extended Contract Inpt Psych Services

  • Psychiatric Hospital Unit
  • Saint Cloud, MN
  • NPI 1932419058
  NPD
• St. Joseph's Medical Center

  dba Essentia Health St. Joseph's-Pillager Clinic

  • Primary Care Clinic/Center
  • Pillager, MN
  • NPI 1891740957
  NPD (past)

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

{
    "created_epoch": "1147305600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1356048000000",
    "number": "1720038714",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1406 6TH AVE N",
            "city": "ST CLOUD",
            "state": "MN",
            "postal_code": "56303",
            "telephone_number": "320-251-2700",
            "fax_number": "320-656-7026"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1406 6TH AVE N",
            "city": "ST CLOUD",
            "state": "MN",
            "postal_code": "56303",
            "telephone_number": "320-251-2700",
            "fax_number": "320-656-7026"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HOLUB",
        "first_name": "MARK",
        "middle_name": "IRVIN",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-05-11",
        "last_updated": "2012-12-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2084P0800X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "MN",
            "license": "33545",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "826305100",
            "state": "MN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Bryce C Holmgren, M.D.
• Leah A Holmgren, MD
• Brittany Holstein
• Jon M Holthusen, LADC
• Jan L. Holtz, PH.D., L.P.
• Leah Holzem
• Emma Hommerding, RBT
• Kayla Hommerding, LPCC
• Kendra Hommerding
• Kristy Hommerding, M.A., L.P.C

• Psychiatry Physician in Saint Cloud, MN
• Providers in Saint Cloud, MN by specialty
• Psychiatry Physician in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 21, 2012; 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.