Individual provider Active NPI

Jenna Heinz, NP

  • Family Nurse Practitioner
  • Sylvania, OH
National Provider Identifier
1083159784
Registry record updated Mar 24, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
APRN.CNP.020333 Issued in OH
Practice address
7135 Sylvania Ave
Building 2, Suite a
Sylvania, OH 43560-5510
Phone
(419) 479-5392
NPI assigned
Jan 4, 2017
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 24, 2017

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X APRN.CNP.020333 OH Primary

Addresses

Primary practice location

7135 Sylvania Ave
Building 2, Suite a
Sylvania, OH 43560-5510

Mailing address

7135 Sylvania Ave
Building 2, Suite a
Sylvania, OH 43560-5510
Phone (419) 479-5392

Other identifiers 1

IdentifierTypeStateIssuer
0201864MedicaidOH

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OH
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20170202000559 OH Practitioner - Nurse Practitioner 4183907942 Reassigns benefits to 2 organizations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
APRN.CNP.020333OHMDFamily Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Mercy Health Physicians Lima Specialty Care LLC CurrentSince Mar 28, 2022 Accepting new patients
Kingston Care Partners, LLC CurrentSince Sep 17, 2021 Accepting new patients

Locations

830 W High St
Ste 390
Lima, OH 45801
Phone (419) 995-4960

1120 Dunaway St
Miamisburg, OH 45342
Phone (937) 307-5949

Organizations & group practices 2

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": "1483488000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1490313600000",
    "number": "1083159784",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7135 SYLVANIA AVE",
            "address_2": "BUILDING 2, SUITE A",
            "city": "SYLVANIA",
            "state": "OH",
            "postal_code": "435605510",
            "telephone_number": "419-479-5392"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7135 SYLVANIA AVE",
            "address_2": "BUILDING 2, SUITE A",
            "city": "SYLVANIA",
            "state": "OH",
            "postal_code": "435605510",
            "telephone_number": "419-479-5392"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HEINZ",
        "first_name": "JENNA",
        "credential": "NP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2017-01-04",
        "last_updated": "2017-03-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "OH",
            "license": "APRN.CNP.020333",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0201864",
            "state": "OH"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Sylvania, OH

Sources for this page

Verify at the official NPI Registry.