Active NPI
Aydan Luke Heavner
- Physician Assistant
- Lillington, NC
National Provider Identifier
1093420697
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physician Assistant
- License
- 001004740
- Practice address
- 4350 US 421 S
Lillington, NC 27546-6760 - Phone
- (910) 893-1210
- NPI assigned
- Jan 18, 2023
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physician Assistant | 363A00000X | 001004740 | NC | Primary |
| Student in an Organized Health Care Education/Training Program | 390200000X |
Addresses
Primary practice location
4350 US 421 S
Lillington, NC 27546-6760
Mailing address
924 Clear Creek Cir
Lincolnton, NC 28092-8005
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in NC
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: No
Enrollment records 1
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Physician Assistant
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 001004740 | NC | MD | Physician Assistant |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Cumberland County Hospital System Inc | Physician Assistant | Current | Accepting new patients |
| Emergency Coverage Services, PC | Physician Assistant | Past | Accepting new patients |
Locations
1638 Owen Dr
Fayetteville, NC 28304
Phone (910) 609-5610
Interoperability endpoints
- aheavner117852@capefearvalley.direct-ci.com
Organizations & group practices 4
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.
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NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1674000000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1705449600000",
"number": "1093420697",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "924 CLEAR CREEK CIR",
"city": "LINCOLNTON",
"state": "NC",
"postal_code": "280928005"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4350 US 421 S",
"city": "LILLINGTON",
"state": "NC",
"postal_code": "275466760",
"telephone_number": "910-893-1210"
}
],
"practiceLocations": [],
"basic": {
"last_name": "HEAVNER",
"first_name": "AYDAN",
"middle_name": "LUKE",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2023-01-18",
"last_updated": "2024-01-17",
"certification_date": "2024-01-17",
"status": "A"
},
"taxonomies": [
{
"code": "363A00000X",
"taxonomy_group": "",
"desc": "Physician Assistant",
"state": "NC",
"license": "001004740",
"primary": true
},
{
"code": "390200000X",
"taxonomy_group": "",
"desc": "Student in an Organized Health Care Education/Training Program",
"state": null,
"license": null,
"primary": false
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Lillington, NC
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 17, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.