Phyllis A. Holtzman, M.D.

Primary specialty

Pediatrics PhysicianTaxonomy code 208000000X

License

029092 Issued in CT

Practice address

1527 Route 12
Gales Ferry, CT 06335-1800

Phone

(860) 464-7248

Fax

(860) 464-0125

NPI assigned

Oct 12, 2006

Last updated

Jul 8, 2007By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 6

Medicare fee-for-service enrollment

Enrolled in CT

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

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: pholtzman48305@direct.ynhh.org

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.

• Northeast Medical Group, Inc.

  • Internal Medicine Physician
  • Bridgeport, CT
  • NPI 1043278351

  Pediatrics

  Medicare reassignment NPD
• Gales Ferry Pediatric Group

  • Medical Specialty Clinic/Center
  • Gales Ferry, CT
  • NPI 1245372176
  NPD (past)

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

{
    "created_epoch": "1160611200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1881783348",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1527 ROUTE 12",
            "address_2": "PO BOX 608",
            "city": "GALES FERRY",
            "state": "CT",
            "postal_code": "063351800",
            "telephone_number": "860-464-7248",
            "fax_number": "860-464-0125"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1527 ROUTE 12",
            "city": "GALES FERRY",
            "state": "CT",
            "postal_code": "063351800",
            "telephone_number": "860-464-7248",
            "fax_number": "860-464-0125"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HOLTZMAN",
        "first_name": "PHYLLIS",
        "middle_name": "A.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-10-12",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "CT",
            "license": "029092",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS",
            "identifier": "010029092CT01",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HEALTH NET",
            "identifier": "031504",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "OXFORD",
            "identifier": "NLP017",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CIGNA",
            "identifier": "01029092",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CONNECTICARE",
            "identifier": "029092",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "001290923",
            "state": "CT"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Sanford Alan Greenhouse, M.D.
• Randall D. Harris, D.D.S.
• Marie Antointeet Healy, L. AC., MSOM
• John Joseph Hennessey, M.D.
• Holistic Mental Wellness Therapy
• Nicholas Houghton
• Naomi Hutchins, PT, ATC
• Sarah Hafeez Ilahi, D.O.
• Jeanette Jezick, OD
• Barbara Kidala, RPH

• Pediatrics Physician in Gales Ferry, CT
• Providers in Gales Ferry, CT by specialty
• Pediatrics Physician in Connecticut

• 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.