Donald Gary Heacock, P.T.

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

15332 Issued in MD

Practice address

7310 Ritchie Hwy
Suite 500
Glen Burnie, MD 21061-3065

Phone

(410) 766-4435

Fax

(410) 766-4437

NPI assigned

Jul 29, 2006

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

Other identifiers 6

Medicare fee-for-service enrollment

Enrolled in MD, DC2 enrollments

Enrollment records 2

Specialty

Physical Therapist in Private Practice

Education

Other, 1982

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Maryland Sportscare and Rehab LLCGroup PAC ID 2860440427, 166 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

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 and National Provider Directory roles.

• Maryland Sportscare & Rehab LLC

  dba Pivot Physical Therapy of Maryland

  • Physical Therapist
  • Westminster, MD
  • NPI 1518951995
  Medicare reassignment Care Compare group NPD
• Glen Burnie Physical Therapy & Sportscare, LLC

  dba Pivot Physical Therapy of Greater Baltimore

  • Physical Therapist
  • Columbia, MD
  • NPI 1679630073
  Medicare reassignment NPD
• Professional Sportscare & Rehab, LLC

  dba Pivot Physical Therapy of Metro DC

  • Clinic/Center
  • Winchester, VA
  • NPI 1033142294

  DC, MD, Physical Therapist

  Medicare reassignment NPD
• Glen Burnie Physical Therapy & Sportscare, LLC

  dba Pivot Physical Therapy of Greater Baltimore

  • Physical Therapist
  • Columbia, MD
  • NPI 1417319211
  NPD
• Maryland Sportscare & Rehab, LLC

  dba Pivot Physical Therapy of Maryland

  • Physical Therapist
  • Westminster, MD
  • NPI 1720445174
  NPD
• Fitness Forum of Maryland, LLC

  • Occupational Therapist
  • Annapolis, MD
  • NPI 1821853441
  NPD (past)
• Fitness Forum of Maryland, LLC

  • Rehabilitation Practitioner
  • Annapolis, MD
  • NPI 1912930835

  Physical Therapist

  NPD (past)

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

{
    "created_epoch": "1154131200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1588809600000",
    "number": "1023022324",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "350 NEW FIDELITY CT",
            "city": "GARNER",
            "state": "NC",
            "postal_code": "275292665",
            "telephone_number": "919-258-2714",
            "fax_number": "410-648-4878"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7310 RITCHIE HWY",
            "address_2": "SUITE 500",
            "city": "GLEN BURNIE",
            "state": "MD",
            "postal_code": "210613065",
            "telephone_number": "410-766-4435",
            "fax_number": "410-766-4437"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HEACOCK",
        "first_name": "DONALD",
        "middle_name": "GARY",
        "name_prefix": "Mr.",
        "credential": "P.T.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-07-29",
        "last_updated": "2020-05-07",
        "certification_date": "2020-05-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "MD",
            "license": "15332",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "756LN288",
            "state": "MD"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ACS / US DEPT OF LABOR",
            "identifier": "147433401",
            "state": "MD"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AETNA USHEALTHCARE",
            "identifier": "1359660",
            "state": "MD"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "OWCP/DEPARTMENT OF LABOR",
            "identifier": "145799600",
            "state": "MD"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "UNITED HEALTHCARE",
            "identifier": "1784629",
            "state": "MD"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "UNITED HEALTH CARE",
            "identifier": "521200786",
            "state": "MD"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Kurt W Hassel, BS, DC, CCSP
• Iesha Haughton
• Milton S Hawkins, LCSW-C
• Alison Green Hayes
• Margaret Hayward, LCPC
• Health Plus Behavioral and Primary Care
• Health Plus Behavioral and Primary Care
• Health Plus Behavioral and Primary Care
• Health Releaf LLC
• Health Releaf LLC (Self)

• Physical Therapist in Glen Burnie, MD
• Providers in Glen Burnie, MD by specialty
• Physical Therapist in Maryland

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 7, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• 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.