Active NPI
Thomas A Holm, PH.D.
- Clinical Psychologist
- Winston Salem, NC
National Provider Identifier
1861427452
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Psychologist
- License
- 682
- Practice address
- 2990 Bethesda PL
Suite 604-B
Winston Salem, NC 27103-3318 - Phone
- (336) 659-8087
- Fax
- (336) 659-8194
- NPI assigned
- Jul 11, 2006
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Psychologist | 103TC0700X | 682 | NC | Primary |
Addresses
Primary practice location
2990 Bethesda PL
Suite 604-B
Winston Salem, NC 27103-3318
Mailing address
2990 Bethesda PL
Suite 604-B
Winston Salem, NC 27103-3318
Phone (336) 659-8087
Other identifiers 4
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 6000482 | Medicaid | NC | |
| 279057 | Other | NC | VALUE OPTIONS |
| 6115017 | Other | NC | UNITED BEHAVIORAL HEALTH |
| 03140 | Other | NC | BLUE CROSS BLUE SHEILD |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: No
- Power mobility devices: No
- Hospice: No
- Opted out of Medicare
- Yes, effective Apr 1, 2019 through Apr 1, 2027
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Philosophy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 682 | NC | MD | Mental Health Counselor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1152576000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1861427452",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2990 BETHESDA PL",
"address_2": "SUITE 604-B",
"city": "WINSTON SALEM",
"state": "NC",
"postal_code": "271033318",
"telephone_number": "336-659-8087",
"fax_number": "336-659-8194"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2990 BETHESDA PL",
"address_2": "SUITE 604-B",
"city": "WINSTON SALEM",
"state": "NC",
"postal_code": "271033318",
"telephone_number": "336-659-8087",
"fax_number": "336-659-8194"
}
],
"practiceLocations": [],
"basic": {
"last_name": "HOLM",
"first_name": "THOMAS",
"middle_name": "A",
"credential": "PH.D.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2006-07-11",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "NC",
"license": "682",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "6000482",
"state": "NC"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "VALUE OPTIONS",
"identifier": "279057",
"state": "NC"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "UNITED BEHAVIORAL HEALTH",
"identifier": "6115017",
"state": "NC"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BLUE CROSS BLUE SHEILD",
"identifier": "03140",
"state": "NC"
}
],
"endpoints": [],
"other_names": []
}Other providers in Winston Salem, NC
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; 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; Opt Out Affidavits.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.