Active NPI
Heather Mackinnon
- Physician Assistant
- Potsdam, NY
National Provider Identifier
1023460607
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physician Assistant
- License
- 019845
- Practice address
- 50 Leroy St
Potsdam, NY 13676-1786 - Phone
- (315) 265-3300
- NPI assigned
- Jul 7, 2016
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physician Assistant | 363A00000X | 019845 | NY | Primary |
Addresses
Primary practice location
50 Leroy St
Potsdam, NY 13676-1786
Mailing address
50 Leroy St
Potsdam, NY 13676-1786
Phone (315) 265-3300
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Physician Assistant
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Canton Potsdam Hospital | Past | Accepting new patients |
Organizations & group practices 1
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.
-
- Physical Therapy Clinic/Center
- Canton, NY
- NPI 1770703522
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1467849600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1672185600000",
"number": "1023460607",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "50 LEROY ST",
"city": "POTSDAM",
"state": "NY",
"postal_code": "136761786",
"telephone_number": "315-265-3300"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "50 LEROY ST",
"city": "POTSDAM",
"state": "NY",
"postal_code": "136761786",
"telephone_number": "315-265-3300"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MACKINNON",
"first_name": "HEATHER",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2016-07-07",
"last_updated": "2022-12-28",
"certification_date": "2022-12-28",
"status": "A"
},
"taxonomies": [
{
"code": "363A00000X",
"taxonomy_group": "",
"desc": "Physician Assistant",
"state": "NY",
"license": "019845",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Potsdam, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 28, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.