JACK HOLLAND CRNA
NPI 1699755231
Nurse Anesthetist, Certified Registered in Heber City, UT
About Jack Holland Crna NPPES
Official registry information on file with the National Plan and Provider Enumeration System.
JACK HOLLAND CRNA (NPI 1699755231) is an individual nurse anesthetist, certified registered in Heber City, Utah, licensed in Utah (9809402-4406) and active in the NPI registry since January 2006. He maintains a secondary practice location in Salt Lake City.
NPPES Registry Identity
Specialties & Licenses 2
Secondary Practice Location 1
Other Identifiers 1
Medicare Participation & PECOS CMS
Medicare enrollment, assignment, billing reassignment, and ordering and referring status from CMS.
Medicare Enrollment Status
Enrolled in Medicare (PECOS)
Jack Holland Crna is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).
Medicare Billing Reassignment
Medicare enrollment records show Jack Holland reassigns Medicare billing to 1 organization. The organization bills Medicare for the services this provider delivers there.
Heber City, UT 84032
- Reassigned Medicare billing, Utah enrollment
- 14 clinicians in this Medicare group
Source: CMS Revalidation Reassignment List, October 2026 release. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.
Frequently Asked Questions NPPES & CMS
Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.
What is Jack Holland's NPI number?
The NPI number for Jack Holland is 1699755231. It was assigned to this individual provider in the NPPES registry on January 19, 2006.
Where is Jack Holland located?
Jack Holland practices at Heber Valley Hospital 1485 Us-40, Heber City, UT 84032. The listed phone number is (435) 654-2500.
What is Jack Holland's specialty?
The primary specialty registered for this NPI is Nurse Anesthetist, Certified Registered with taxonomy code 367500000X.
Is Jack Holland enrolled in Medicare?
Yes. Jack Holland is registered in the Medicare PECOS enrollment system.
Which organization bills Medicare for Jack Holland's services?
According to the CMS Revalidation Reassignment List (October 2026 release), Jack Holland reassigns Medicare benefits to Legacy Anesthesia LLC (Heber City, UT). The reassignment is filed with Medicare on form CMS-855R, signed by both the clinician and the organization, and lets the organization bill Medicare and receive payment for Jack Holland's services. Reassignment records can lag staffing changes; confirm current arrangements with the organization.
When was this NPI record last updated?
The NPPES record for Jack Holland was last updated on October 26, 2021. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 4 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.
# Jack Holland, CRNA · NPI 1699755231
Nurse Anesthetist, Certified Registered physician in Heber City, Utah. Individual provider, active in the CMS NPPES registry since January 19, 2006.
## Identity
- **NPI:** 1699755231 (Entity type: Individual)
- **Enumerated:** January 19, 2006
- **Primary specialty:** Nurse Anesthetist, Certified Registered · taxonomy 367500000X
- **State license:** 9809402-4406 (Utah)
- **Sole proprietor:** No
## Practice location
- **Address:** HEBER VALLEY HOSPITAL, 1485 US-40, Heber City, UT 84032
- **Phone:** (435) 654-2500
## Medicare
- **Medicare:** Enrolled in Medicare (PECOS)
- **Bills Medicare through:** Legacy Anesthesia LLC (NPI 1851764112, Heber City, UT), under Medicare reassignment (form CMS-855R) · CMS Revalidation Reassignment List, October 2026 release
## Record status
- **NPPES last updated:** October 26, 2021
- **Other identifiers:** Medicaid 8051521 (NC)
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Source: [NPI Profile](https://npiprofile.com/npi/1699755231) · Data from the CMS NPPES public registry.