Jacob Holloway

Primary specialty

General Acute Care HospitalTaxonomy code 282N00000X

License

58-2329008 Issued in GA

Practice address

4500 Hospital Blvd Ste 230
Roswell, GA 30076

Phone

(470) 956-4560

Fax

(770) 475-8968

NPI assigned

Jun 25, 2013

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Electronic endpoints 1

Medicare fee-for-service enrollment

Enrolled in GA

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Specialty

General Surgery

Education

University of Texas Medical School at San Antonio, 2013

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Wellstar Medical Group LLCGroup PAC ID 6709065402, 3,059 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Wellstar North Fulton Medical Center Hospital, Roswell, GA, CCN 110198

Merit-based Incentive Payment System (MIPS)

Final score

93.93 of 100Reported as apm

Quality

82.14

Promoting interoperability

100

Improvement activities

40

Procedures performed for Medicare patients

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: jacob.holloway.p189@direct.tenet.nextgenshare.com
• Direct secure messaging: jacob.holloway.p53@direct.tenet.nextgenshare.com

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.

• Wellstar Medical Group, LLC

  • Family Medicine Physician
  • Kennesaw, GA
  • NPI 1558664003
  Medicare reassignment Care Compare group NPD
• Wellstar Medical Group, LLC

  • Multi-Specialty Clinic/Center
  • Marietta, GA
  • NPI 1275992240
  NPD
• Wellstar North Fulton Hospital, Inc

  • General Acute Care Hospital
  • Roswell, GA
  • NPI 1750312997
  NPD (past)

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

• Wellstar North Fulton Hospital, Inc

  • General Acute Care Hospital
  • Roswell, GA
  • NPI 1750312997
  Care Compare affiliation

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

{
    "created_epoch": "1372118400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1569456000000",
    "number": "1831538743",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4500 HOSPITAL BLVD STE 230",
            "city": "ROSWELL",
            "state": "GA",
            "postal_code": "300760001",
            "telephone_number": "470-956-4560",
            "fax_number": "770-475-8968"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4500 HOSPITAL BLVD STE 230",
            "city": "ROSWELL",
            "state": "GA",
            "postal_code": "30076",
            "telephone_number": "470-956-4560",
            "fax_number": "770-475-8968"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "303 Parkway Dr NE",
            "address_purpose": "LOCATION",
            "city": "Atlanta",
            "state": "GA",
            "postal_code": "303121212",
            "country_code": "US",
            "telephone_number": "404-265-4411",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "303 Parkway Dr NE",
            "address_purpose": "LOCATION",
            "city": "Atlanta",
            "state": "GA",
            "postal_code": "303121212",
            "country_code": "US",
            "telephone_number": "404-265-4411",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "HOLLOWAY",
        "first_name": "JACOB",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2013-06-25",
        "last_updated": "2019-09-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "282N00000X",
            "taxonomy_group": "",
            "desc": "General Acute Care Hospital",
            "state": "GA",
            "license": "58-2329008",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "jholloway124369@directwellstar.org",
            "affiliation": "N",
            "address_1": "4500 Hospital Blvd Ste 230",
            "city": "Roswell",
            "state": "GA",
            "country_code": "US",
            "postal_code": "300760001",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Tammy Helen Holcomb, LPCS
• Christian Holliday, DC
• Edward H. Holliger, M.D.
• Magdalen Holliger, MD
• Naomi Holloman
• Audline Maria Holmes, PMHNP
• Taylor Brooke Holsten
• Home Health Options Inc.
• Homestead Palliative Care, Inc
• Honeybee Homecare Holdco LLC

• General Acute Care Hospital in Roswell, GA
• Providers in Roswell, GA by specialty
• General Acute Care Hospital in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 26, 2019; 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.