Individual provider Active NPI

Holly Green, PA

  • Physician Assistant
  • Edmond, OK
National Provider Identifier
1750873154
Registry record updated May 31, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
Practice address
4801 Integris Pkwy
Edmond, OK 73034-8864
Phone
(719) 237-7990
NPI assigned
May 31, 2018
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 31, 2018

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X Primary

Addresses

Primary practice location

4801 Integris Pkwy
Edmond, OK 73034-8864

Mailing address

3250 Billy CT
Edmond, OK 73034-9347

Other names 1

  • Holly Hutchison Former name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OK
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
I20210827000078 OK Practitioner - Physician Assistant 9931504081 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2018
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Inpatient Care Physician Services LLCGroup PAC ID 5092839357, 11 clinicians

Practice addresses (Care Compare)

1409 Territories Dr
Edmond, OK 73034-2650
Phone (405) 657-3120

Hospital & facility affiliations

  • Integris Health Edmond Hospital Hospital, Edmond, OK, CCN 370236
  • Integris Baptist Medical Center, Inc Hospital, Oklahoma City, OK, CCN 370028

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
2923OKMDPhysical Therapy Assistant

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 and National Provider Directory roles.

Hospital & facility affiliations 5

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": "1527724800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1527724800000",
    "number": "1750873154",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3250 BILLY CT",
            "city": "EDMOND",
            "state": "OK",
            "postal_code": "730349347"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4801 INTEGRIS PKWY",
            "city": "EDMOND",
            "state": "OK",
            "postal_code": "730348864",
            "telephone_number": "719-237-7990"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GREEN",
        "first_name": "HOLLY",
        "credential": "PA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2018-05-31",
        "last_updated": "2018-05-31",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "HOLLY",
            "last_name": "HUTCHISON",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Edmond, OK

Sources for this page

Verify at the official NPI Registry.