NPIMap

Individual provider Active NPI

Susan Kim Holland, M.D.

  • Dermatopathology Physician
  • Eustis, FL
National Provider Identifier
1891816674
Registry record updated Oct 3, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Dermatopathology PhysicianTaxonomy code 207ND0900X
License
64562 Issued in GA
Practice address
2100 Prevatt St
Eustis, FL 32726-6130
Phone
(352) 308-8903
Fax
(352) 460-0785
NPI assigned
Apr 2, 2007
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 3, 2019

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice Physician 208D00000X 64562 GA
Dermatopathology Physician 207ND0900X 64562 GA Primary

Addresses

Primary practice location

2100 Prevatt St
Eustis, FL 32726-6130

Mailing address

7001 Hodgson Memorial Dr
Suite 5
Savannah, GA 31406-2549
Phone (912) 349-7656

Other practice location 1

7001 Hodgson Memorial Dr
Suite 5
Savannah, GA 31406-2549
Phone (912) 349-7656

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)
Not enrolled
HHS exclusion list flag
Flagged The directory lists this NPI on an HHS exclusion list. The OIG exclusions file (LEIE) holds no record for this NPI, and the directory does not say which list the flag comes from. How exclusions are shown Confirm with the OIG exclusions search.
Credentials
Doctor of Medicine

Practice roles

OrganizationSpecialtyStatusNew patients
Gary R Kutsikovich MD and Associates Inc Past Accepting new patients
Des Plaines Dermatology, LTD. Past Accepting new patients
Mohs Surgery &Dermatology Past Accepting new patients

Organizations & group practices 3

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": "1175472000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1570060800000",
    "number": "1891816674",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7001 HODGSON MEMORIAL DR",
            "address_2": "SUITE 5",
            "city": "SAVANNAH",
            "state": "GA",
            "postal_code": "314062549",
            "telephone_number": "912-349-7656",
            "fax_number": "912-349-7659"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2100 PREVATT ST",
            "city": "EUSTIS",
            "state": "FL",
            "postal_code": "327266130",
            "telephone_number": "352-308-8903",
            "fax_number": "352-460-0785"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "7001 Hodgson Memorial Dr",
            "address_2": "Suite 5",
            "address_purpose": "LOCATION",
            "city": "Savannah",
            "state": "GA",
            "postal_code": "314062549",
            "country_code": "US",
            "telephone_number": "912-349-7656",
            "fax_number": "912-349-7659",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "HOLLAND",
        "first_name": "SUSAN",
        "middle_name": "KIM",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-04-02",
        "last_updated": "2019-10-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208D00000X",
            "taxonomy_group": "",
            "desc": "General Practice",
            "state": "GA",
            "license": "64562",
            "primary": false
        },
        {
            "code": "207ND0900X",
            "taxonomy_group": "",
            "desc": "Dermatology, Dermatopathology",
            "state": "GA",
            "license": "64562",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Eustis, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 3, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.