Active NPI
Jeremiah Henry Holleman Jr., M.D.
- Vascular Surgery Physician
- Charlotte, NC
National Provider Identifier
1891707675
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Vascular Surgery Physician
- License
- 28044
- Practice address
- 1000 Blythe Blvd
4TH Floor
Charlotte, NC 28203-5812 - Phone
- (704) 355-8188
- Fax
- (704) 355-8192
- NPI assigned
- Aug 12, 2006
- 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 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Surgery Physician | 208600000X | 28044 | NC | |
| Vascular Surgery Physician | 2086S0129X | 28044 | NC | Primary |
Addresses
Primary practice location
1000 Blythe Blvd
4TH Floor
Charlotte, NC 28203-5812
Mailing address
PO Box 601067
Charlotte, NC 28260-1067
Phone (704) 355-8188
Other identifiers 5
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 43110 | Other | NC | BCBS |
| 7943110 | Medicaid | NC | |
| 1891707675 | Medicaid | NC | |
| P00245246 | Other | RAILROAD MEDICARE | |
| N28044 | Medicaid | SC |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 28044 | NC | MD | Pharmacist |
| 12085 | NC | MD | Occupational Therapy Assistant |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1155340800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1398643200000",
"number": "1891707675",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 601067",
"city": "CHARLOTTE",
"state": "NC",
"postal_code": "282601067",
"telephone_number": "704-355-8188",
"fax_number": "704-355-8192"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1000 BLYTHE BLVD",
"address_2": "4TH FLOOR",
"city": "CHARLOTTE",
"state": "NC",
"postal_code": "282035812",
"telephone_number": "704-355-8188",
"fax_number": "704-355-8192"
}
],
"practiceLocations": [],
"basic": {
"last_name": "HOLLEMAN",
"first_name": "JEREMIAH",
"middle_name": "HENRY",
"name_suffix": "Jr.",
"credential": "M.D.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-08-12",
"last_updated": "2014-04-28",
"status": "A"
},
"taxonomies": [
{
"code": "208600000X",
"taxonomy_group": "",
"desc": "Surgery",
"state": "NC",
"license": "28044",
"primary": false
},
{
"code": "2086S0129X",
"taxonomy_group": "",
"desc": "Surgery, Vascular Surgery",
"state": "NC",
"license": "28044",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BCBS",
"identifier": "43110",
"state": "NC"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "7943110",
"state": "NC"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "1891707675",
"state": "NC"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "RAILROAD MEDICARE",
"identifier": "P00245246",
"state": null
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "N28044",
"state": "SC"
}
],
"endpoints": [],
"other_names": []
}Other providers in Charlotte, NC
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 28, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.