Individual provider Active NPI

Roy Winford Holeyfield Jr., MD

  • Internal Medicine Physician
  • Temecula, CA
National Provider Identifier
1932298288
Registry record updated Dec 14, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
G081103 Issued in CA
Practice address
41935 Vardon Drive
Temecula, CA 92591
Phone
(402) 813-0279
NPI assigned
Oct 12, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 14, 2016

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X G081103 CA Primary

Addresses

Primary practice location

41935 Vardon Drive
Temecula, CA 92591

Mailing address

41935 Vardon Drive
Temecula, CA 92591
Phone (402) 813-0279

Other identifiers 1

IdentifierTypeStateIssuer
47063291413MedicaidNE

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

LicenseStateTypeSpecialty
G081103CAMDInternal Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Great Plains Internal Medicine PC Mne Internal Medicine Current Accepting new patients

Locations

12717 S 28th Ave
Bellevue, NE 68123
Phone (402) 502-3723

401 E Gold Coast Rd
Ste 333
Papillion, NE 68046
Phone (402) 592-5140

Organizations & group practices 1

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": "1160611200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1481673600000",
    "number": "1932298288",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "41935 VARDON DRIVE",
            "city": "TEMECULA",
            "state": "CA",
            "postal_code": "92591",
            "telephone_number": "402-813-0279"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "41935 VARDON DRIVE",
            "city": "TEMECULA",
            "state": "CA",
            "postal_code": "92591",
            "telephone_number": "402-813-0279"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HOLEYFIELD",
        "first_name": "ROY",
        "middle_name": "WINFORD",
        "name_prefix": "Mr.",
        "name_suffix": "Jr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-10-12",
        "last_updated": "2016-12-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "CA",
            "license": "G081103",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "47063291413",
            "state": "NE"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Temecula, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 14, 2016; 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.