Individual provider Active NPI

Matthew Heeden, CRNA

  • Certified Registered Nurse Anesthetist
  • Greensboro, NC
National Provider Identifier
1093098774
Registry record updated May 31, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Certified Registered Nurse AnesthetistTaxonomy code 367500000X
License
2140 Issued in NC
Practice address
705 Green Valley Road
Greensboro, NC 27408
Phone
(336) 272-0012
NPI assigned
Sep 20, 2011
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 31, 2024

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Registered Nurse 163W00000X 211948 NC
Certified Registered Nurse Anesthetist 367500000X 2140 NC Primary

Addresses

Primary practice location

705 Green Valley Road
Greensboro, NC 27408

Mailing address

21 A Oak Branch Dr
Greensboro, NC 27407-2145
Phone (336) 478-2664

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NC

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20120118000406 NC Practitioner - Certified Registered Nurse Anesthetist (Crna) 6608043534 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
211948NCMDRegistered Nurse
2140NCMDPhysical Therapy Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Surgical Center of Greensboro, LLC Current Accepting new patients
Gate City Anesthesia, Inc CurrentSince Oct 28, 2011 Accepting new patients

Locations

21 Oak Branch Dr
#A
Greensboro, NC 27407

21A Oak Branch Dr
Greensboro, NC 27407
Phone (336) 478-2664

705 Green Valley Rd
Greensboro, NC 27408
Phone (336) 272-0012

1211 Virginia St
Greensboro, NC 27401
Phone (336) 272-0012

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": "1316476800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1717113600000",
    "number": "1093098774",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "21 A OAK BRANCH DR",
            "city": "GREENSBORO",
            "state": "NC",
            "postal_code": "274072145",
            "telephone_number": "336-478-2664",
            "fax_number": "336-851-0374"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "705 GREEN VALLEY ROAD",
            "city": "GREENSBORO",
            "state": "NC",
            "postal_code": "27408",
            "telephone_number": "336-272-0012"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HEEDEN",
        "first_name": "MATTHEW",
        "name_prefix": "Mr.",
        "credential": "CRNA",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2011-09-20",
        "last_updated": "2024-05-31",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "163W00000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse",
            "state": "NC",
            "license": "211948",
            "primary": false
        },
        {
            "code": "367500000X",
            "taxonomy_group": "",
            "desc": "Nurse Anesthetist, Certified Registered",
            "state": "NC",
            "license": "2140",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Greensboro, NC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 31, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.