Individual provider Active NPI

Heidi Beutler

  • Pediatrics Physician
  • New York, NY
National Provider Identifier
1053385864
Registry record updated Aug 14, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatrics PhysicianTaxonomy code 208000000X
License
1733741 Issued in NY
Practice address
Columbia University Department Pediatrics
3959 Broadway
New York, NY 10032
Phone
(212) 304-7297
Fax
(212) 544-1974
NPI assigned
Feb 16, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 14, 2012

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatrics Physician 208000000X 1733741 NY Primary

Addresses

Primary practice location

Columbia University Department Pediatrics
3959 Broadway
New York, NY 10032

Mailing address

116 Pinehurst Ave
New York, NY 10033-1755
Phone (212) 470-0393

Other identifiers 1

IdentifierTypeStateIssuer
01142772MedicaidNC

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NY
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20110119000715 NY Practitioner - Pediatric MedicinePractitioner - General Practice 9739368077 Reassigns benefits to 2 organizations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
1733741NYMDPediatrics Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Trustees of Columbia University in the City of New York Pediatrics CurrentSince Mar 1, 2015 Accepting new patients
Trustees of Columbia University in the City of New York CurrentSince Mar 1, 2015 Accepting new patients
Trustees of Columbia University in the City of New York Pediatrics Current Accepting new patients

Locations

630 W 168th St
#112
New York, NY 10032
Phone (212) 304-7297

622 W 168th St
#1624
New York, NY 10032

161 Fort Washington Ave
New York, NY 10032
Phone (212) 305-8559

622 W 168th St
New York, NY 10032
Phone (212) 305-4931

3959 Broadway
New York, NY 10032
Phone (212) 304-7297

2026 Richmond Rd
Staten Island, NY 10306
Phone (212) 305-2300

Interoperability endpoints

  • FHIR API: https://epicproxy-pub.et1089.epichosted.com/FHIRProxy/api/FHIR/R4/
  • FHIR API: https://epicproxy-pub.et1089.epichosted.com/FHIRProxy/api/FHIR/DSTU2/

Organizations & group practices 3

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.

NPI Registry JSON

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

{
    "created_epoch": "1140048000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1344902400000",
    "number": "1053385864",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "116 PINEHURST AVE",
            "city": "NEW YORK",
            "state": "NY",
            "postal_code": "100331755",
            "telephone_number": "212-470-0393"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "COLUMBIA UNIVERSITY DEPARTMENT PEDIATRICS",
            "address_2": "3959 BROADWAY",
            "city": "NEW YORK",
            "state": "NY",
            "postal_code": "10032",
            "telephone_number": "212-304-7297",
            "fax_number": "212-544-1974"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BEUTLER",
        "first_name": "HEIDI",
        "name_prefix": "Dr.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-02-16",
        "last_updated": "2012-08-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "NY",
            "license": "1733741",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "01142772",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in New York, NY

Sources for this page

Verify at the official NPI Registry.