Individual provider Active NPI

David G Heidemann, MD

  • Ophthalmology Physician
  • Southfield, MI
National Provider Identifier
1073504122
Registry record updated Jul 28, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Ophthalmology PhysicianTaxonomy code 207W00000X
License
4301048651 Issued in MI
Practice address
29201 Telegraph Rd
Suite 101
Southfield, MI 48034-1331
Phone
(248) 350-1130
Fax
(248) 350-2709
NPI assigned
Oct 28, 2005
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jul 28, 2022

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Ophthalmology Physician 207W00000X 4301048651 MI Primary

Addresses

Primary practice location

29201 Telegraph Rd
Suite 101
Southfield, MI 48034-1331

Mailing address

29201 Telegraph Rd
Suite 101
Southfield, MI 48034-1331
Phone (248) 350-1130

Other practice location 1

3535 W 13 Mile Rd Ste 555
Royal Oak, MI 48073-6770
Phone (248) 551-2020

Other identifiers 1

IdentifierTypeStateIssuer
1818756MedicaidMI

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address dheidemann17356@direct.beaumont.edu

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MI
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
I20031126000234 MI Practitioner - Ophthalmology 1557265998 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Ophthalmology
Education
Wayne State University School of Medicine, 1982
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Beaumont Medical Group- Specialty ServicesGroup PAC ID 7214299866, 868 clinicians

Practice addresses (Care Compare)

28100 Grand River Ave
Farmington Hills, MI 48336-5970

3535 W 13 Mile Rd
Royal Oak, MI 48073-6770

Hospital & facility affiliations

  • Beaumont Hospital Royal Oak Hospital, Royal Oak, MI, CCN 230130

Merit-based Incentive Payment System (MIPS)

Final score
84.37 of 100Reported as group
Quality
66.73
Promoting interoperability
100
Improvement activities
40
Cost
70.98

Procedures performed for Medicare patients

ProcedureNumber of procedures
Cataract surgery1-10

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Beaumont Medical Group- Specialty Services CurrentSince Mar 21, 2018 Accepting new patients

Locations

28100 Grand River Ave
Ste 301
Farmington Hills, MI 48336
Phone (947) 521-1320

44405 Woodward Ave
Pontiac, MI 48341
Phone (248) 858-3000

3535 W 13 Mile Rd
Royal Oak, MI 48073
Phone (248) 551-1010

3601 W 13 Mile Rd
Royal Oak, MI 48073

3535 W 13 Mile Rd
Ste 555
Royal Oak, MI 48073
Phone (248) 551-2020

Interoperability endpoints

  • Direct secure messaging: dheidemann17356@direct.beaumont.edu

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.

Hospital & facility affiliations 3

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1130457600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1658966400000",
    "number": "1073504122",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "29201 TELEGRAPH RD",
            "address_2": "SUITE 101",
            "city": "SOUTHFIELD",
            "state": "MI",
            "postal_code": "480341331",
            "telephone_number": "248-350-1130",
            "fax_number": "248-350-2709"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "29201 TELEGRAPH RD",
            "address_2": "SUITE 101",
            "city": "SOUTHFIELD",
            "state": "MI",
            "postal_code": "480341331",
            "telephone_number": "248-350-1130",
            "fax_number": "248-350-2709"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "3535 W 13 Mile Rd Ste 555",
            "address_purpose": "LOCATION",
            "city": "Royal Oak",
            "state": "MI",
            "postal_code": "480736770",
            "country_code": "US",
            "telephone_number": "248-551-2020",
            "fax_number": "248-551-2267",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "HEIDEMANN",
        "first_name": "DAVID",
        "middle_name": "G",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2005-10-28",
        "last_updated": "2022-07-28",
        "certification_date": "2022-07-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207W00000X",
            "taxonomy_group": "",
            "desc": "Ophthalmology",
            "state": "MI",
            "license": "4301048651",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1818756",
            "state": "MI"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "dheidemann17356@direct.beaumont.edu",
            "affiliation": "N",
            "address_1": "3535 W 13 Mile Rd Ste 555",
            "city": "Royal Oak",
            "state": "MI",
            "country_code": "US",
            "postal_code": "480736770",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Southfield, MI

Sources for this page

Verify at the official NPI Registry.