Individual provider Active NPI

Shelby Holmes, FNP

  • Family Nurse Practitioner
  • Ogden, UT
National Provider Identifier
1861988107
Registry record updated May 4, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
8635821-4405 Issued in UT
Practice address
698 12TH St
Ogden, UT 84404-6200
Phone
(801) 475-3700
NPI assigned
Jul 10, 2018
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 4, 2021

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X 8635821-4405 UT Primary

Addresses

Primary practice location

698 12TH St
Ogden, UT 84404-6200

Mailing address

PO Box 5546
Denver, CO 80217-5546
Phone (801) 475-3500

Other identifiers 1

IdentifierTypeStateIssuer
1861988107MedicaidUT

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in UT
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 1

Enrollment IDStateProvider typePAC IDDetails
I20181113003307 UT Practitioner - Nurse Practitioner 8729332580 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2018
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Ogden Clinic PCGroup PAC ID 9638078033, 104 clinicians

Practice addresses (Care Compare)

4650 Harrison Blvd
Ogden, UT 84403-4303
Phone (801) 475-3010

4700 Harrison Blvd
Ogden, UT 84403-4303
Phone (801) 475-3010

5495 S 500
Suite 310
Ogden, UT 84405-7409
Phone (801) 475-3100

6112 S 1550
Ogden, UT 84405-5007
Phone (801) 475-3800

698 12TH St
Ogden, UT 84404-6200
Phone (801) 475-3700

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
8635821-4405UTMDFamily Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Ogden Clinic Specialty Services LLC Current Accepting new patients
Ogden Clinic PC Family Medicine CurrentSince Sep 17, 2018 Accepting new patients

Locations

5495 S 500 E
Ste 310
Ogden, UT 84405
Phone (801) 475-3100

698 12th St
Ogden, UT 84404
Phone (801) 475-3700

4650 Harrison Blvd
Ogden, UT 84403
Phone (801) 475-3481

1491 E Ridgeline Dr
South Ogden, UT 84405
Phone (317) 790-7550

Interoperability endpoints

  • FHIR API: https://fhir4.healow.com/fhir/r4/JJJGBA

Organizations & group practices 2

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.

NPI Registry JSON

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

{
    "created_epoch": "1531180800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1620086400000",
    "number": "1861988107",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 5546",
            "city": "DENVER",
            "state": "CO",
            "postal_code": "802175546",
            "telephone_number": "801-475-3500",
            "fax_number": "801-475-3494"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "698 12TH ST",
            "city": "OGDEN",
            "state": "UT",
            "postal_code": "844046200",
            "telephone_number": "801-475-3700"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HOLMES",
        "first_name": "SHELBY",
        "credential": "FNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2018-07-10",
        "last_updated": "2021-05-04",
        "certification_date": "2021-05-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "UT",
            "license": "8635821-4405",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1861988107",
            "state": "UT"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Ogden, UT

Sources for this page

Verify at the official NPI Registry.