Holley Medical Aesthetics PLLC

Primary specialty

Plastic and Reconstructive Surgery PhysicianTaxonomy code 2086S0122X

Legal business name

HOLLEY MEDICAL AESTHETICS PLLC

Practice address

8175 Creekside Dr Ste 100
Portage, MI 49024-5370

Phone

(269) 222-1611

Fax

(269) 222-1607

NPI assigned

Jul 26, 2023

Organization subpart

No

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

Authorized official

Name

Scott Holley, MDNPI 1811994841

Title

Physician

Phone

(269) 222-1611

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in MI

Enrollment records 1

Locations

Practitioners 4

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Scott Donald Holley, M.D., F.A.C.S.

  • Plastic Surgery Physician
  • Portage, MI
  • NPI 1811994841
  Medicare reassignment NPD Authorized official
• Kelly J Pasch, FNP

  • Family Nurse Practitioner
  • Portage, MI
  • NPI 1245782804
  Medicare reassignment NPD
• Elizabeth Petruska Knapp, MS, PA-C

  • Surgical Physician Assistant
  • Portland, OR
  • NPI 1427360346

  MI

  Medicare reassignment
• Morgan Ellis Decker, MD

  • Dermatology Physician
  • Grosse Pointe Park, MI
  • NPI 1144857285
  NPD (past)

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

{
    "created_epoch": "1690329600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1690329600000",
    "number": "1801577671",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8175 CREEKSIDE DR STE 100",
            "city": "PORTAGE",
            "state": "MI",
            "postal_code": "490245370",
            "telephone_number": "269-222-1611",
            "fax_number": "269-222-1607"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8175 CREEKSIDE DR STE 100",
            "city": "PORTAGE",
            "state": "MI",
            "postal_code": "490245370",
            "telephone_number": "269-222-1611",
            "fax_number": "269-222-1607"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "HOLLEY MEDICAL AESTHETICS PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-07-26",
        "last_updated": "2023-07-26",
        "certification_date": "2023-07-26",
        "status": "A",
        "authorized_official_last_name": "HOLLEY",
        "authorized_official_first_name": "SCOTT",
        "authorized_official_title_or_position": "PHYSICIAN",
        "authorized_official_telephone_number": "269-222-1611",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "2086S0122X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Surgery, Plastic and Reconstructive Surgery",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Kyle Hoeft
• Denise L Hoffman, OTR/L
• Abigail Hoge
• Meredith Ayers Holland
• Kevin Holleman
• Scott Donald Holley, M.D., F.A.C.S.
• Tamara Hollon
• John Christian Holtrop, MD
• Simon Hoogendyk, M.D.
• Brandon J Hooks, D.O.

• Plastic and Reconstructive Surgery Physician in Portage, MI
• Providers in Portage, MI by specialty
• Plastic and Reconstructive Surgery Physician in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 26, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.