Individual provider Active NPI

Hollie Dawn Cleveland, CRNP

  • Family Nurse Practitioner
  • Dothan, AL
National Provider Identifier
1720790603
Registry record updated Feb 3, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
1-078349 Issued in AL
Practice address
210 Westside Dr
Dothan, AL 36303-1928
Phone
(334) 793-5074
NPI assigned
Dec 22, 2022
Last updated
Feb 3, 2023By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 3, 2023

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X 1-078349 AL Primary

Addresses

Primary practice location

210 Westside Dr
Dothan, AL 36303-1928

Mailing address

PO Box 6599
Dothan, AL 36302-6599
Phone (334) 793-5074

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in AL
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
I20230130000901 AL Practitioner - Nurse Practitioner 2365813391 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2022
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Wiregrass Clinic LLCGroup PAC ID 2860662491, 69 clinicians

Practice addresses (Care Compare)

210 Westside Dr
Dothan, AL 36303-1928
Phone (334) 793-5074

4300 W Main St
Dothan, AL 36305-1058

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
87.97 of 100Reported as apm
Quality
75.95
Promoting interoperability
100
Improvement activities
40

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Wiregrass Clinic LLC Family CurrentSince Mar 13, 2023 Accepting new patients

Locations

210 Westside Dr
Dothan, AL 36303
Phone (334) 793-5074

4300 W Main St
Ste 21
Dothan, AL 36305
Phone (334) 699-7900

Interoperability endpoints

  • Direct secure messaging: hollie.cleveland.1@3326.direct.athenahealth.com

Ownership & related parties

All facility ownership & control disclosures 1

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
Coremedical GroupAbbeville, AL, CCN 015373 Skilled nursing facility Corporate Officer Dec 20, 2016

Owned or controlled facilities with NPI records 1

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

Organizations & group practices 1

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 4

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": "1671667200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1675382400000",
    "number": "1720790603",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 6599",
            "city": "DOTHAN",
            "state": "AL",
            "postal_code": "363026599",
            "telephone_number": "334-793-5074"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "210 WESTSIDE DR",
            "city": "DOTHAN",
            "state": "AL",
            "postal_code": "363031928",
            "telephone_number": "334-793-5074"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CLEVELAND",
        "first_name": "HOLLIE",
        "middle_name": "DAWN",
        "credential": "CRNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2022-12-22",
        "last_updated": "2023-02-03",
        "certification_date": "2023-02-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "AL",
            "license": "1-078349",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Dothan, AL

Sources for this page

Verify at the official NPI Registry.