NPIMap

Individual provider Active NPI

Breeanna Holdaway, ACNP

  • Acute Care Nurse Practitioner
  • Salt Lake City, UT
National Provider Identifier
1962749010
Registry record updated Oct 20, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Acute Care Nurse PractitionerTaxonomy code 363LA2100X
License
2012009665 Issued in UT
Practice address
8 TH Avenue & C St
Central Tower 5
Salt Lake City, UT 84143-0001
Phone
(801) 408-3617
NPI assigned
Jan 9, 2013
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 20, 2022

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Acute Care Nurse Practitioner 363LA2100X 2012009665 UT Primary

Addresses

Primary practice location

8 TH Avenue & C St
Central Tower 5
Salt Lake City, UT 84143-0001

Mailing address

1113 E 3580 S
Salt Lake City, UT 84106-2438
Phone (435) 452-1961

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address BHOLDAWAY23359@DIRECT.MED.UTAH.EDU Direct University of Utah

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in UT
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20130506000523 UT Practitioner - Nurse Practitioner 6608013966 Reassigns benefits to 4 organizations

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2012
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
University of Utah Adult ServicesGroup PAC ID 0941525273, 1,758 clinicians

Practice addresses (Care Compare)

50 N Medical Dr
Salt Lake City, UT 84132-0100
Phone (801) 585-3229

Hospital & facility affiliations

  • University of Utah Hospital and Clinics Hospital, Salt Lake City, UT, CCN 460009

Merit-based Incentive Payment System (MIPS)

Final score
89.77 of 100Reported as group
Quality
91.47
Promoting interoperability
100
Improvement activities
40
Cost
74.42

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
2012009665UTMDAcute Care Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
University of Utah Acuity Care Services CurrentSince Sep 11, 2019 Accepting new patients
University of Utah Surgical Services CurrentSince Sep 11, 2019 Accepting new patients
University of Utah Adult Services CurrentSince Jul 1, 2016 Accepting new patients
Ihc Health Services Inc Current Accepting new patients
University of Utah Acuity Care Services Current Accepting new patients
University of Utah Surgical Services CurrentSince Sep 11, 2019 Accepting new patients
University of Utah Adult Services CurrentSince Jul 1, 2016 Accepting new patients
Ihc Health Services Inc CurrentSince Apr 15, 2013 Accepting new patients
University of Utah Adult Services Current Accepting new patients
University of Utah Surgical Services Current Accepting new patients
University of Utah Acuity Care Services CurrentSince Sep 11, 2019 Accepting new patients
Bronson Lakeview Hospital Past Accepting new patients

Locations

5121 S Cottonwood St
Salt Lake Cty, UT 84107
Phone (801) 408-8998

555 Foothill Dr
Slc, UT 84112
Phone (801) 581-7589

175 N Medical Dr
Slc, UT 84112
Phone (801) 581-6908

1280 E Stringham Ave
Slc, UT 84106
Phone (801) 213-9077

50 N Medical Dr
Slc, UT 84132
Phone (801) 581-2292

Organizations & group practices 17

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.

View all 17

Hospital & facility affiliations 3

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

NPI Registry JSON

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

{
    "created_epoch": "1357689600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1666224000000",
    "number": "1962749010",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1113 E 3580 S",
            "city": "SALT LAKE CITY",
            "state": "UT",
            "postal_code": "841062438",
            "telephone_number": "435-452-1961"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8 TH AVENUE & C ST",
            "address_2": "CENTRAL TOWER 5",
            "city": "SALT LAKE CITY",
            "state": "UT",
            "postal_code": "841430001",
            "telephone_number": "801-408-3617"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HOLDAWAY",
        "first_name": "BREEANNA",
        "credential": "ACNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2013-01-09",
        "last_updated": "2022-10-20",
        "certification_date": "2022-10-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LA2100X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Acute Care",
            "state": "UT",
            "license": "2012009665",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "BHOLDAWAY23359@DIRECT.MED.UTAH.EDU",
            "affiliation": "Y",
            "affiliationName": "University of Utah",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "CDA/CCD/TXT",
            "address_1": "50 N Medical Dr",
            "city": "Salt Lake City",
            "state": "UT",
            "country_code": "US",
            "postal_code": "841320001",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Salt Lake City, UT

Sources for this page

Verify at the official NPI Registry.