Individual provider Active NPI

Robert L Holmes, D.O., PH.D.

  • Family Medicine Physician
  • Carbondale, IL
National Provider Identifier
1861466393
Registry record updated Dec 28, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
036-081188 Issued in IL
Practice address
305 W Jackson St
Ste 200
Carbondale, IL 62901-1474
Phone
(618) 453-7777
Fax
(618) 453-1102
NPI assigned
Feb 13, 2006
Last updated
Dec 28, 2020By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 28, 2020

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 036-081188 IL Primary

Addresses

Primary practice location

305 W Jackson St
Ste 200
Carbondale, IL 62901-1474

Mailing address

305 W Jackson St
Ste 200
Carbondale, IL 62901-1474
Phone (618) 453-7777

Other practice location 1

2553 Ken Gray Blvd
West Frankfort, IL 62896-4174
Phone (618) 932-3937

Other identifiers 1

IdentifierTypeStateIssuer
036081188MedicaidIL

Electronic endpoints 2

TypeEndpointUseAffiliation
Direct Messaging Address robertholmes@siusm.allscriptsdirect.net
Direct Messaging Address rholmes15985@sih.direct-ci.com

Medicare participation

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

Enrollment IDStateProvider typePAC IDDetails
I20100719000473 IL Practitioner - Family Practice 9931231487 Reassigns benefits to 2 organizations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Osteopathy, Doctor of Philosophy

State licenses

LicenseStateTypeSpecialty
036-081188ILMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Southern Illinois Hospital Services Family Medicine CurrentSince Feb 26, 2018 Accepting new patients
Siu Physicians & Surgeons, Inc CurrentSince Nov 1, 1997 Accepting new patients
Southern Illinois Hospital Services Current Accepting new patients
Siu Physicians & Surgeons, Inc Family Medicine CurrentSince Nov 1, 1997 Accepting new patients
Southern Illinois Hospital Services CurrentSince Feb 26, 2018 Accepting new patients

Locations

305 W Jackson St
Ste 200
Carbondale, IL 62901
Phone (618) 453-3777

2 S Hospital Dr
Murphysboro, IL 62966
Phone (618) 684-3156

751 N Rutledge St
Springfield, IL 62702
Phone (217) 545-0182

2553 Ken Gray Blvd
West Frankfort, IL 62896
Phone (618) 932-2155

Interoperability endpoints

  • Direct secure messaging: rholmes15985@sih.direct-ci.com
  • Direct secure messaging: robertholmes@siusm.allscriptsdirect.net

Organizations & group practices 5

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": "1139788800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1609113600000",
    "number": "1861466393",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "305 W JACKSON ST",
            "address_2": "STE 200",
            "city": "CARBONDALE",
            "state": "IL",
            "postal_code": "629011474",
            "telephone_number": "618-453-7777",
            "fax_number": "618-453-1102"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "305 W JACKSON ST",
            "address_2": "STE 200",
            "city": "CARBONDALE",
            "state": "IL",
            "postal_code": "629011474",
            "telephone_number": "618-453-7777",
            "fax_number": "618-453-1102"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2553 Ken Gray Blvd",
            "address_purpose": "LOCATION",
            "city": "West Frankfort",
            "state": "IL",
            "postal_code": "628964174",
            "country_code": "US",
            "telephone_number": "618-932-3937",
            "fax_number": "618-932-2734",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "HOLMES",
        "first_name": "ROBERT",
        "middle_name": "L",
        "credential": "D.O., PH.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-02-13",
        "last_updated": "2020-12-28",
        "certification_date": "2020-12-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "IL",
            "license": "036-081188",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "036081188",
            "state": "IL"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "robertholmes@siusm.allscriptsdirect.net",
            "affiliation": "N",
            "address_1": "305 W Jackson St",
            "address_2": "STE 200",
            "city": "Carbondale",
            "state": "IL",
            "country_code": "US",
            "postal_code": "629011474",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "rholmes15985@sih.direct-ci.com",
            "affiliation": "N",
            "address_1": "2553 Ken Gray Blvd",
            "city": "West Frankfort",
            "state": "IL",
            "country_code": "US",
            "postal_code": "628964174",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Carbondale, IL

Sources for this page

Verify at the official NPI Registry.