Individual provider Active NPI

Farren C Holman, DPT

  • Physical Therapist
  • Wentzville, MO
National Provider Identifier
1790071322
Registry record updated Jul 21, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
License
2011019601 Issued in MO
Practice address
1832 Wentzville Pkwy
Wentzville, MO 63385-3817
Phone
(636) 327-7110
NPI assigned
Jun 22, 2011
Last updated
Jul 21, 2019By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 21, 2019

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Therapist 225100000X 2011019601 MO Primary

Addresses

Primary practice location

1832 Wentzville Pkwy
Wentzville, MO 63385-3817

Mailing address

4273 Keaton Crossing Blvd
O Fallon, MO 63368-8220
Phone (636) 206-4225

Other names 1

  • Farren C Wise Former name

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20110818000203 MO Practitioner - Physical Therapist in Private Practice 8820267396 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physical Therapist in Private Practice
Education
Other, 2011
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Axes Physical Therapy LLCGroup PAC ID 3375840028, 112 clinicians

Practice addresses (Care Compare)

1348 Bass Pro Dr
Saint Charles, MO 63301-2461
Phone (636) 757-5075

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

Practice roles

OrganizationSpecialtyStatusNew patients
Axes Physical Therapy, LLC Physical Therapist CurrentSince Sep 17, 2018 Accepting new patients
Axes Physical Therapy, LLC Physical Therapist CurrentSince Sep 17, 2018 Accepting new patients

Locations

1195 Hazel Ln
Farmington, MO 63640
Phone (573) 756-2937

7025 Howdershell Rd
Ste E
Hazelwood, MO 63042
Phone (314) 750-0000

4273 Keaton Crossing Blvd
O Fallon, MO 63368
Phone (636) 206-4225

1348 Bass Pro Dr
Saint Charles, MO 63301
Phone (636) 757-5075

7483 Mexico Rd
Saint Peters, MO 63376
Phone (636) 206-3654

2018 Phoenix Center Dr
Washington, MO 63090
Phone (314) 718-4560

718 Luetkenhaus Blvd
Wentzville, MO 63385
Phone (636) 445-5001

Interoperability endpoints

  • Direct secure messaging: farren.holman.p2@direct.athleticoltd.nextgenshare.com

Organizations & group practices 3

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.

NPI Registry JSON

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

{
    "created_epoch": "1308700800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1563667200000",
    "number": "1790071322",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4273 KEATON CROSSING BLVD",
            "city": "O FALLON",
            "state": "MO",
            "postal_code": "633688220",
            "telephone_number": "636-206-4225"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1832 WENTZVILLE PKWY",
            "city": "WENTZVILLE",
            "state": "MO",
            "postal_code": "633853817",
            "telephone_number": "636-327-7110"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HOLMAN",
        "first_name": "FARREN",
        "middle_name": "C",
        "credential": "DPT",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2011-06-22",
        "last_updated": "2019-07-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "MO",
            "license": "2011019601",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "FARREN",
            "last_name": "WISE",
            "middle_name": "C",
            "credential": "DPT",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Wentzville, MO

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 21, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.