Active NPI
Robert L Holmes, D.O., PH.D.
- Family Medicine Physician
- Carbondale, IL
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Medicine Physician
- License
- 036-081188
- 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, 2020
- Sex
- Male
- Sole proprietor
- No
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 |
|---|---|---|---|---|
| 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
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 036081188 | Medicaid | IL |
Electronic endpoints 2
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| 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
Enrollment records 1
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Osteopathy, Doctor of Philosophy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 036-081188 | IL | MD | Family Medicine Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Southern Illinois Hospital Services | Family Medicine | Current | Accepting new patients |
| Siu Physicians & Surgeons, Inc | Current | Accepting new patients | |
| Southern Illinois Hospital Services | Current | Accepting new patients | |
| Siu Physicians & Surgeons, Inc | Family Medicine | Current | Accepting new patients |
| Southern Illinois Hospital Services | Current | 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
- rholmes15985@sih.direct-ci.com
- 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.
-
dba SIU HealthCare
- Endocrinology, Diabetes & Metabolism Physician
- Springfield, IL
- NPI 1558385989
Family Medicine
-
dba Herrin Hospital
- General Acute Care Hospital
- Herrin, IL
- NPI 1528158573
-
- Durable Medical Equipment & Medical Supplies
- Springfield, IL
- NPI 1164055976
-
dba West Frankfort Family Medicine
- Family Medicine Physician
- West Frankfort, IL
- NPI 1154408581
-
dba St. Joseph Memorial Hospital
- Medicare Defined Swing Bed Hospital Unit
- Murphysboro, IL
- NPI 1639595036
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
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 28, 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.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.