Individual provider Active NPI

Jodie Darlene Holmes, ARNP

  • Dermatology Physician
  • Germantown, TN
National Provider Identifier
1770036337
Registry record updated Feb 24, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Dermatology PhysicianTaxonomy code 207N00000X
License
26431 Issued in TN
Practice address
7658 Poplar Pike
Advanced Dermatology
Germantown, TN 38138-3813
Phone
(901) 759-2322
Fax
(563) 578-3322
NPI assigned
Aug 1, 2016
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 24, 2020

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Family Health Clinical Nurse Specialist 364SF0001X A116063 IA
Dermatology Physician 207N00000X 26431 TN Primary

Addresses

Primary practice location

7658 Poplar Pike
Advanced Dermatology
Germantown, TN 38138-3813

Mailing address

5352 Ambassador LN W
Apt 203
Arlington, TN 38002-4953
Phone (319) 327-7188

Other practice location 1

5349 Airline Rd
Arlington, TN 38002-4266
Phone (901) 759-2322

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TN
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
I20200210002783 TN Practitioner - Nurse Practitioner 4183910797 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2016
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Advanced Dermatology and Skin Cancer Associates, PLLCGroup PAC ID 2163501834, 12 clinicians

Practice addresses (Care Compare)

7658 Poplar Pike
Germantown, TN 38138-5941
Phone (901) 322-2322

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
26431TNMDPharmacist
A116063IAMDFamily Health Clinical Nurse Specialist

Practice roles

OrganizationSpecialtyStatusNew patients
The Wootton Clinic and Medical Center, P.C. CurrentSince Dec 10, 2019 Accepting new patients
Advanced Dermatology and Skin Cancer Associates, PLLC CurrentSince Dec 30, 2019 Accepting new patients
Semmes-Murphey Clinic PC PastSince Dec 30, 2019 Accepting new patients
Floyd County Memorial Hospital Commission Past Accepting new patients

Locations

7203 Goodman Rd
Olive Branch, MS 38654
Phone (901) 759-2322

1650 Bonnie Ln
Ste 102
Cordova, TN 38016
Phone (901) 756-2424

7730 Wolf River Blvd
Ste 112
Germantown, TN 38138
Phone (901) 755-9211

7658 Poplar Pike
Memphis, TN 38138
Phone (901) 322-2322

Organizations & group practices 4

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.

NPI Registry JSON

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

{
    "created_epoch": "1470009600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1582502400000",
    "number": "1770036337",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5352 AMBASSADOR LN W",
            "address_2": "APT 203",
            "city": "ARLINGTON",
            "state": "TN",
            "postal_code": "380024953",
            "telephone_number": "319-327-7188"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7658 POPLAR PIKE",
            "address_2": "ADVANCED DERMATOLOGY",
            "city": "GERMANTOWN",
            "state": "TN",
            "postal_code": "381383813",
            "telephone_number": "901-759-2322",
            "fax_number": "563-578-3322"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "5349 Airline Rd",
            "address_purpose": "LOCATION",
            "city": "Arlington",
            "state": "TN",
            "postal_code": "380024266",
            "country_code": "US",
            "telephone_number": "901-759-2322",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "HOLMES",
        "first_name": "JODIE",
        "middle_name": "DARLENE",
        "credential": "ARNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2016-08-01",
        "last_updated": "2020-02-24",
        "certification_date": "2020-02-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "364SF0001X",
            "taxonomy_group": "",
            "desc": "Clinical Nurse Specialist, Family Health",
            "state": "IA",
            "license": "A116063",
            "primary": false
        },
        {
            "code": "207N00000X",
            "taxonomy_group": "",
            "desc": "Dermatology",
            "state": "TN",
            "license": "26431",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Germantown, TN

Sources for this page

Verify at the official NPI Registry.