Holly Renee Clemons, MD is a medicare enrolled "Family Medicine" physician in Sullivan, Illinois. She went to Morehouse School Of Medicine and graduated in 2011 and has 14 years of diverse experience with area of expertise as Family Practice. She is a member of the group practice Northside Primary Care Professional Services,llc and her current practice location is
7 Hawthorne Ln Ste A, Sullivan, Illinois. You can reach out to her office (for appointments etc.) via phone at
(217) 728-8441.
Holly Renee Clemons is licensed to practice in Illinois (license number 036160654) and she also participates in the medicare program. She
accepts medicare assignments (which means she accepts the Medicare-approved amount; you will not be billed for any more than the Medicare deductible and coinsurance) and her NPI Number is 1528354560.
Physician's Profile
| Full Name | Holly Renee Clemons |
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| Gender | Female |
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| Speciality | Family Practice |
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| Experience | 14 Years |
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| Location | 7 Hawthorne Ln Ste A, Sullivan, Illinois |
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| Accepts Medicare Assignments | Yes. She accepts the Medicare-approved amount; you will not be billed for any more than the Medicare deductible and coinsurance. |
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Medical Education and Training:
- Holly Renee Clemons attended and graduated from Morehouse School Of Medicine in 2011
NPI Data:
- NPI Number: 1528354560
- Provider Enumeration Date: 06/28/2011
- Last Update Date: 12/11/2023
Medicare PECOS Information:
- PECOS PAC ID: 7911154794
- Enrollment ID: I20140929001351
Medical Identifiers
Medical identifiers for Holly Renee Clemons such as npi, medicare ID, medicare PIN, medicaid, etc.
| Identifier | Type | State | Issuer |
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| 1528354560 | NPI | - | NPPES |
Medical Taxonomies and Licenses
| Taxonomy | Type | License (State) | Status |
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| 207Q00000X | Family Medicine | 71921 (Georgia) | Secondary |
| 207Q00000X | Family Medicine | 68597 (Arizona) | Secondary |
| 207Q00000X | Family Medicine | 036160654 (Illinois) | Primary |
Group Practice Association
| Group Practice Name | Group PECOS PAC ID | No. of Members |
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| Northside Primary Care Professional Services,llc | 9638343924 | 266 |
Medicare Reassignments
Some practitioners may not bill the customers directly but medicare billing happens through clinics / group practice / hospitals where the provider works. Medicare reassignment of benefits is a mechanism by which practitioners allow third parties to bill and receive payment for medicare services performed by them. Holly Renee Clemons allows following entities to bill medicare on her behalf.
| Entity Name | The Emory Clinic Inc |
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| Entity Type | Part B Supplier - Clinic/group Practice |
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| Entity Identifiers | NPI Number: 1396798229
PECOS PAC ID: 8820901408
Enrollment ID: O20031110000503 |
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| Entity Name | The Southeast Permanente Medical Group |
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| Entity Type | Part B Supplier - Clinic/group Practice |
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| Entity Identifiers | NPI Number: 1245266956
PECOS PAC ID: 6204829013
Enrollment ID: O20040407000370 |
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| Entity Name | Northside Primary Care Professional Services,llc |
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| Entity Type | Part B Supplier - Clinic/group Practice |
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| Entity Identifiers | NPI Number: 1922397553
PECOS PAC ID: 9638343924
Enrollment ID: O20111123000206 |
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Medicare Part D Prescriber Enrollment
Any physician or other eligible professional who prescribes Part D drugs must either enroll in the Medicare program or opt out in order to prescribe drugs to their patients with Part D prescription drug benefit plans. Holly Renee Clemons is
enrolled with medicare and thus, if eligible, can prescribe medicare part D drugs to patients with medicare part D benefits.
Mailing Address and Practice Location
| Mailing Address | Practice Location Address |
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Holly Renee Clemons, MD
777 Hemlock St,
Macon, GA 31201-2102
Ph: (478) 633-5500 | Holly Renee Clemons, MD
7 Hawthorne Ln Ste A,
Sullivan, IL 61951-9490
Ph: (217) 728-8441 |
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