CHARLES MATTHEW HOLLIS, CRNA — NPI 1780903021 (Licensed & Credentialed Physician Assistants & Advanced Practice Nursing Providers — Nurse Anesthetist, Certified Registered in POPLAR BLUFF, MO)

CMS-1500 Box 24J / 33a • NPI

1780903021

Type 1 Individual Rendering/Ordering

HIPAA NUCC Taxonomy • CMS Code

367500000X (CMS 43)

Licensed & Credentialed Physician Assistants & Advanced Practice Nursing Providers — Nurse Anesthetist, Certified Registered

Box 32 Service Location & ZIP+4

2620 N WESTWOOD BLVD, POPLAR BLUFF, MO, 63901-3396

✓ 9-Digit EDI 837 ZIP+4 (63901-3396)

Practice Phone & Referral Fax

(573) 785-7721

Direct NPPES Verification Line

✓ HHS OIG LEIE Sanction Screening — VERIFIED CLEAR: NPI 1780903021 (CHARLES MATTHEW HOLLIS, CRNA) has 0 active federal exclusions across all 84,224 HHS OIG LEIE sanction records (Database Verified: 2026-11-11).

CMS Medicare Order & Referring PECOS Eligibility

This practitioner does not currently appear in the CMS individual Order & Referring PECOS file (may practice in pediatrics, commercial-only networks, or hospital-employed settings).

Official CMS NPPES Credential & Practice Profile

10-Digit NPI Number	`1780903021` (NPI-1 Individual Practitioner)
Provider / Legal Name	CHARLES MATTHEW HOLLIS, CRNA
Plain-English Specialty	Licensed & Credentialed Physician Assistants & Advanced Practice Nursing Providers — Nurse Anesthetist, Certified Registered NUCC Code: `367500000X` (Nurse Anesthetist, Certified Registered)
Certifying / Licensing Body	State Medical / Healthcare Licensing Board & National Specialty Board
Practice Location Address	2620 N WESTWOOD BLVD, POPLAR BLUFF, MO, 63901-3396
Practice Telephone / Fax	Tel: (573) 785-7721
Administrative Mailing Address	247 COUNTY ROAD 738, BROOKLAND, AR, 72417-8522
Enumeration & Last Sync	Enumerated: 2010-05-26 \| CMS Record Updated: 2010-05-26

Clinic Location, Accessibility & Directions

📍 Practice Location & Patient Access

2620 N WESTWOOD BLVD, POPLAR BLUFF, MO, 63901-3396

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Plain-English Taxonomy & CMS Crosswalk (367500000X)

What Does Taxonomy Code 367500000X Mean?

In the HIPAA National Uniform Claim Committee (NUCC) classification, code 367500000X translates to:
"Licensed & Credentialed Physician Assistants & Advanced Practice Nursing Providers — Nurse Anesthetist, Certified Registered"

CMS-1500 Medicare Specialty Crosswalk: CMS Code 43 (Certified Registered Nurse Anesthetist (CRNA))
Certifying / Accrediting Authority: State Medical / Healthcare Licensing Board & National Specialty Board
Clinical Scope: Consult a verified Nurse Anesthetist, Certified Registered for specialized diagnostic evaluation, treatment planning, and continuity of care.

Specialty Clinical Procedures & Therapeutic Classes

Standard Scope of Care (CHARLES MATTHEW HOLLIS, CRNA)

Typical CPT / Diagnostic Procedures:

Comprehensive Outpatient & Inpatient Clinical Evaluation (CPT 99202–99215)
Diagnostic Workup, Laboratory Ordering & Evidence-Based Care Coordination
Preventive Screening, Patient Counseling & Multidisciplinary Referral

Common Therapeutic Classes:

Evidence-Based Specialty Pharmacotherapy & Preventive Regimens (CMS Part D Standard)

All Registered NUCC Taxonomies & State Licenses

Taxonomy Code & Plain-English Description	State License & Primary Status
`367500000X` — Nurse Anesthetist, Certified Registered Plain English: Licensed & Credentialed Physician Assistants & Advanced Practice Nursing Providers — Nurse Anesthetist, Certified Registered	State: MO \| License: `2010014759` \| Primary: Yes (Primary)

Medical Billing, RCM & Hospital Credentialing Teams:

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CHARLES MATTHEW HOLLIS, CRNA (NPI #1780903021)