Mark E. Holthouse, M.D.

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

G757170 Issued in CA

Practice address

3104 Ponte Morino Drive
Ste 110
Cameron Park, CA 95682

Phone

(530) 676-1003

Fax

(530) 676-7350

NPI assigned

Jun 28, 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

Other identifiers 1

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 Jul 1, 2018 through Jul 1, 2028

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.

• Placerville Family Practice Medical Group, Inc

  • Family Medicine Physician
  • Placerville, CA
  • NPI 1508884073
  NPD
• Kristine Burke MD, Inc.

  • Family Medicine Physician
  • Folsom, CA
  • NPI 1417179714
  NPD (past)

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

{
    "created_epoch": "1151452800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1228262400000",
    "number": "1740217207",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3104 PONTE MORINO DR STE 110",
            "city": "CAMERON PARK",
            "state": "CA",
            "postal_code": "956828282",
            "telephone_number": "530-676-1003",
            "fax_number": "530-676-7350"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3104 PONTE MORINO DRIVE",
            "address_2": "STE 110",
            "city": "CAMERON PARK",
            "state": "CA",
            "postal_code": "95682",
            "telephone_number": "530-676-1003",
            "fax_number": "530-676-7350"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HOLTHOUSE",
        "first_name": "MARK",
        "middle_name": "E.",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-06-28",
        "last_updated": "2008-12-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "CA",
            "license": "G757170",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "GR0070790",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Ann Lee Haslund, M.F.T
• Alex S Haydon, MA
• Jeffrey J Henefeld, PA-C
• Jamara Hicks
• James M Holt, F.N.P.
• Sarah M Howlett
• Debra Ann Ialeggio, MFT
• Infant Parent Center
• Innovative Treatment Associates
• Innovative Treatment Associates Inc

• Family Medicine Physician in Cameron Park, CA
• Providers in Cameron Park, CA by specialty
• Family Medicine Physician in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 3, 2008; 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.