Ivey Ellis Holt, PA

Primary specialty

Surgical Physician AssistantTaxonomy code 363AS0400X

License

006742 Issued in GA

Practice address

6262 Veterans Pkwy
Columbus, GA 31909-3540

Phone

(706) 324-6661

Fax

(706) 494-3201

NPI assigned

Mar 13, 2013

Last updated

Nov 19, 2020By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 3

Medicare fee-for-service enrollment

Enrolled in GA, AL2 enrollments

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 2

Specialty

Physician Assistant

Education

Other, 2012

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Hughston Clinic PCGroup PAC ID 1355254780, 111 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Jack Hughston Memorial Hospital Hospital, Phenix City, AL, CCN 010168

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: ivey.holt.1@321.direct.athenahealth.com
• Direct secure messaging: ivey.holt@sfhga.gadirect.net

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.

• Hughston Clinic, P.C.

  • Orthopaedic Surgery Physician
  • Columbus, GA
  • NPI 1164461190

  AL

  Medicare reassignment Care Compare group NPD
• St. Francis Physician Practices LLC

  dba St. Francis Primary Care

  • Family Medicine Physician
  • Columbus, GA
  • NPI 1326749417
  Medicare reassignment
• Hughston Clinic, PC

  • Durable Medical Equipment & Medical Supplies
  • Newnan, GA
  • NPI 1902682347
  NPD
• St Francis Physician Practices LLC

  dba St. Francis Psychiatrists

  • Psychiatry Physician
  • Columbus, GA
  • NPI 1124493564
  NPD
• Hospital Authority of the City of Bainbridge and Decatur County

  dba Memorial Hospital and Manor

  • Multi-Specialty Clinic/Center
  • Bainbridge, GA
  • NPI 1053388256
  NPD (past)
• St Francis Physician Practices LLC

  dba SFH Electrophysiologist Group

  • Clinical Cardiac Electrophysiology Physician
  • Columbus, GA
  • NPI 1982079323
  NPD (past)
• St. Francis Orthopaedic Institute LLC

  • Orthopaedic Surgery Physician
  • Columbus, GA
  • NPI 1831272582
  NPD (past)

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

• Russell County Community Hospital LLC

  dba Jack Hughston Memorial Hospital

  • General Acute Care Hospital
  • Phenix City, AL
  • NPI 1023050101
  Care Compare affiliation

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

{
    "created_epoch": "1363132800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1605744000000",
    "number": "1831430032",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 370",
            "city": "FORTSON",
            "state": "GA",
            "postal_code": "318080370",
            "fax_number": "706-494-3008"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6262 VETERANS PKWY",
            "city": "COLUMBUS",
            "state": "GA",
            "postal_code": "319093540",
            "telephone_number": "706-324-6661",
            "fax_number": "706-494-3201"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "4340 Kings Way",
            "address_purpose": "LOCATION",
            "city": "Valdosta",
            "state": "GA",
            "postal_code": "316026921",
            "country_code": "US",
            "telephone_number": "229-333-9736",
            "fax_number": "229-333-0225",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "522 N Center St",
            "address_purpose": "LOCATION",
            "city": "Thomaston",
            "state": "GA",
            "postal_code": "302863695",
            "country_code": "US",
            "telephone_number": "706-646-4371",
            "fax_number": "706-646-4372",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "107 Calumet Center Rd",
            "address_purpose": "LOCATION",
            "city": "LaGrange",
            "state": "GA",
            "postal_code": "302416705",
            "country_code": "US",
            "telephone_number": "706-884-3274",
            "fax_number": "706-882-2940",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "100 N Macon St",
            "address_purpose": "LOCATION",
            "city": "Macon",
            "state": "GA",
            "postal_code": "312106563",
            "country_code": "US",
            "telephone_number": "478-200-6970",
            "fax_number": "478-216-5976",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "512 N Shady Ln",
            "address_purpose": "LOCATION",
            "city": "Dothan",
            "state": "AL",
            "postal_code": "363032991",
            "country_code": "US",
            "telephone_number": "334-699-5747",
            "fax_number": "334-699-5750",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "HOLT",
        "first_name": "IVEY",
        "middle_name": "ELLIS",
        "name_prefix": "Mrs.",
        "credential": "PA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2013-03-13",
        "last_updated": "2020-11-19",
        "certification_date": "2020-11-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AS0400X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Surgical",
            "state": "GA",
            "license": "006742",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "147458",
            "state": "AL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "STATE LICENSE",
            "identifier": "006742",
            "state": "GA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "003132870",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Dameka Holston
• Nicole Holston
• Angela Holsy
• Ashley Holt
• Eari L Holt
• Laura Holt
• Matthew Leland Holt, PHARMD
• Mollie Allen Holt, OTR/L
• Phyleatha Holt
• Shelly Holt

• Surgical Physician Assistant in Columbus, GA
• Providers in Columbus, GA by specialty
• Surgical Physician Assistant in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 19, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• 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.