Coty John Holm

Primary specialty

Surgical Physician AssistantTaxonomy code 363AS0400X

License

MED-PAC-LIC-91036 Issued in MT

Practice address

500 W Broadway St
Missoula, MT 59802-4008

Phone

(406) 329-5615

NPI assigned

Aug 23, 2019

Last updated

May 21, 2021By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Electronic endpoints 2

Medicare fee-for-service enrollment

Enrolled in MT

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

Specialty

Physician Assistant

Education

Other, 2020

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Providence Health and Services MtGroup PAC ID 6608786306, 358 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• St. Patrick Hospital Hospital, Missoula, MT, CCN 270014

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: cholm1147528@wm.providencedirect.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.

• Providence Health & Services Mt

  dba St Patrick Hospital Rehab

  • Rehabilitation Hospital Unit
  • Missoula, MT
  • NPI 1144319138
  Medicare reassignment Care Compare group
• Providence Health & Services Mt

  dba Providence Medical Group Montana

  • Family Medicine Physician
  • Missoula, MT
  • NPI 1215222617
  NPD
• Providence Health & Services Mt

  dba PMG MT IHI Montana Cardiology

  • Interventional Cardiology Physician
  • Missoula, MT
  • NPI 1649401076
  NPD

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

• Providence Health & Services Mt

  dba Providence St Patrick Hospital

  • General Acute Care Hospital
  • Missoula, MT
  • NPI 1023032588
  Care Compare affiliation
• Providence Health & Services Mt

  dba Montana Cancer Center at Providence St. Patrick Hospital

  • Medical Oncology Physician
  • Missoula, MT
  • NPI 1326483587

  Hospital

  Care Compare affiliation
• Providence Health & Services Mt

  dba St Patrick Hospital Pathology

  • Anatomic Pathology & Clinical Pathology Physician
  • Missoula, MT
  • NPI 1366185928

  Hospital

  Care Compare affiliation
• Providence Health & Services Mt

  dba St Patrick Hospital Psych

  • Psychiatric Hospital Unit
  • Missoula, MT
  • NPI 1619058302
  Care Compare affiliation

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

{
    "created_epoch": "1566518400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1621555200000",
    "number": "1902453855",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 12",
            "city": "LIBERTY LAKE",
            "state": "WA",
            "postal_code": "990190012",
            "telephone_number": "406-329-5615"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "500 W BROADWAY ST",
            "city": "MISSOULA",
            "state": "MT",
            "postal_code": "598024008",
            "telephone_number": "406-329-5615"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "4311 11th Avenue NE",
            "address_2": "Suite 200",
            "address_purpose": "LOCATION",
            "city": "Seattle",
            "state": "WA",
            "postal_code": "981056367",
            "country_code": "US",
            "telephone_number": "206-616-4001",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "HOLM",
        "first_name": "COTY",
        "middle_name": "JOHN",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2019-08-23",
        "last_updated": "2021-05-21",
        "certification_date": "2021-05-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AS0400X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Surgical",
            "state": "MT",
            "license": "MED-PAC-LIC-91036",
            "primary": true
        },
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "OTHERS",
            "endpointTypeDescription": "Other URL",
            "endpoint": "EPIC",
            "affiliation": "N",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "address_1": "500 W Broadway St",
            "city": "Missoula",
            "state": "MT",
            "country_code": "US",
            "postal_code": "598024008",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "cholm1147528@wm.providencedirect.org",
            "affiliation": "N",
            "use": "DIRECT",
            "useDescription": "Direct",
            "address_1": "500 W Broadway St",
            "city": "Missoula",
            "state": "MT",
            "country_code": "US",
            "postal_code": "598024008",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Lindsey Marie Hollern, D.D.S.
• Amanda Rae Holloron, PMHNP-BC
• Matthew S Holloway
• Ursula Encell Holloway, LCSW
• Alyssa Holly, LCSW
• Shirley Marie O'Hearn Holm, LMT
• Geoffrey Dutton Holman, MD
• Phillip M Holman, M.D.
• Heather R Holmes, DPT
• Kevin Richard Holmes, DPT, OCS

• Surgical Physician Assistant in Missoula, MT
• Providers in Missoula, MT by specialty
• Surgical Physician Assistant in Montana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 21, 2021; 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.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.