Kyle Hollenback

Primary specialty

Medical Physician AssistantTaxonomy code 363AM0700X

License

1330 Issued in ID

Practice address

2280 American Legion Blvd
Mountain Home, ID 83647-3142

Phone

(208) 587-3988

Fax

(208) 587-3324

NPI assigned

Dec 10, 2015

Last updated

Feb 19, 2020By 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 1

Addresses

Medicare fee-for-service enrollment

Enrolled in UT

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, 2015

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Ihc Health Services IncGroup PAC ID 1850209420, 3,948 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Intermountain Health Logan Regional Hospital Hospital, Logan, UT, CCN 460015

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

Practice roles

Locations

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.

• Ihc Health Services Inc

  • Multi-Specialty Clinic/Center
  • Sandy, UT
  • NPI 1942325154
  Medicare reassignment Care Compare group
• Ihc Health Services Inc

  dba Lehi InstaCare

  • Urgent Care Clinic/Center
  • Lehi, UT
  • NPI 1164911962
  NPD
• Ihc Health Services, Inc.

  dba St George Adolescent Partial Hospitalization

  • Psychiatry Physician
  • St George, UT
  • NPI 1023843844
  NPD

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

• Ihc Health Services Inc

  dba Intermountain Health Logan Regional Hospital

  • General Acute Care Hospital
  • Logan, UT
  • NPI 1831108497
  Care Compare affiliation

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

{
    "created_epoch": "1449705600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1582070400000",
    "number": "1932574381",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "486 W 1ST AVE",
            "city": "GLENNS FERRY",
            "state": "ID",
            "postal_code": "836232701"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2280 AMERICAN LEGION BLVD",
            "city": "MOUNTAIN HOME",
            "state": "ID",
            "postal_code": "836473142",
            "telephone_number": "208-587-3988",
            "fax_number": "208-587-3324"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "486 W 1st Ave",
            "address_purpose": "LOCATION",
            "city": "Glenns Ferry",
            "state": "ID",
            "postal_code": "836232701",
            "country_code": "US",
            "telephone_number": "208-366-7416",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "HOLLENBACK",
        "first_name": "KYLE",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2015-12-10",
        "last_updated": "2020-02-19",
        "certification_date": "2020-02-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "ID",
            "license": "1330",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Crystal Herrera, MSOT, OTR/L
• Saad Hijazi, MD
• Kristin Anne Hildebrandt, MD
• Christine Elizabeth Hobbs, OTR/L
• Jacob Hohenshelt, RDN
• Joseph Wells Hoskin, PA-C
• HSC Dental LLC
• Justin Robert Humber
• Donna M Hunter, LCSW
• Idaho Behavioral Health, Inc.

• Medical Physician Assistant in Mountain Home, ID
• Providers in Mountain Home, ID by specialty
• Medical Physician Assistant in Idaho

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 19, 2020; 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.