Individual provider Active NPI

Gregory H Holles, MD

  • Family Medicine Physician
  • Beaverton, OR
National Provider Identifier
1750320206
Registry record updated Dec 17, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
MD22095 Issued in OR
Practice address
2935 SW Cedar Hills Blvd
Beaverton, OR 97005-1342
Phone
(503) 352-6000
Fax
(503) 352-6081
NPI assigned
Jun 6, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 17, 2019

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X MD22095 OR Primary

Addresses

Primary practice location

2935 SW Cedar Hills Blvd
Beaverton, OR 97005-1342

Mailing address

PO Box 6149
Aloha, OR 97007-0149
Phone (503) 352-8657

Other identifiers 1

IdentifierTypeStateIssuer
MD22095OtherORLICENSE

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OR
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

Enrollment IDStateProvider typePAC IDDetails
I20051215000015 OR Practitioner - Family Practice 4688560287

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

Interoperability endpoints

  • Direct secure messaging: gholles6462@direct.ochin.org

NPI Registry JSON

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

{
    "created_epoch": "1149552000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1576540800000",
    "number": "1750320206",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 6149",
            "city": "ALOHA",
            "state": "OR",
            "postal_code": "970070149",
            "telephone_number": "503-352-8657",
            "fax_number": "503-352-8658"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2935 SW CEDAR HILLS BLVD",
            "city": "BEAVERTON",
            "state": "OR",
            "postal_code": "970051342",
            "telephone_number": "503-352-6000",
            "fax_number": "503-352-6081"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HOLLES",
        "first_name": "GREGORY",
        "middle_name": "H",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-06-06",
        "last_updated": "2019-12-17",
        "certification_date": "2019-12-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "OR",
            "license": "MD22095",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "LICENSE",
            "identifier": "MD22095",
            "state": "OR"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Beaverton, OR

Sources for this page

Verify at the official NPI Registry.