Individual provider Active NPI

Philip A Heavner, M.D.

  • Pediatrics Physician
  • Sayre, PA
National Provider Identifier
1093773111
Registry record updated Mar 4, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatrics PhysicianTaxonomy code 208000000X
License
234803 Issued in NY
Practice address
1 Guthrie SQ
Sayre, PA 18840-1625
Phone
(570) 888-5858
NPI assigned
May 1, 2006
Last updated
Mar 4, 2021By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 4, 2021

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 234803 NY Primary

Addresses

Primary practice location

1 Guthrie SQ
Sayre, PA 18840-1625

Mailing address

1 Guthrie SQ
Sayre, PA 18840-1625
Phone (570) 888-5858

Other practice location 1

1 Atwell Rd
Cooperstown, NY 13326-1301
Phone (607) 547-7980

Other identifiers 1

IdentifierTypeStateIssuer
02657225MedicaidNY

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address pheavner153232@direct-guthrie.org Direct

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NY, PA2 enrollments
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 2

Enrollment IDStateProvider typePAC IDDetails
I20050608000962 NY Practitioner - Pediatric Medicine 5799745873 Reassigns benefits to 2 organizations
I20200508002447 PA Practitioner - Pediatric Medicine 5799745873 Reassigns benefits to 1 organization

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
234803NYMDPediatrics Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Mary Imogene Bassett Hospital CurrentSince Jun 15, 2014 Accepting new patients
Guthrie Medical Group, P.C. CurrentSince Jan 1, 2020 Accepting new patients
Mary Imogene Bassett Hospital CurrentSince Jun 15, 2014 Accepting new patients
Guthrie Medical Group, P.C. CurrentSince Jan 1, 2020 Accepting new patients
Guthrie Medical Group, P.C. CurrentSince Apr 1, 2020 Accepting new patients
Guthrie Medical Group, P.C. Current Accepting new patients
Robert Packer Hospital Past Accepting new patients
Guthrie Medical Group PC Past Accepting new patients

Locations

178 Grandview Dr
Cobleskill, NY 12043
Phone (518) 254-3456

1 Atwell Rd
Cooperstown, NY 13326
Phone (607) 547-3480

130 Center Way
Corning, NY 14830
Phone (607) 936-9971

4057 West Rd
Cortland, NY 13045
Phone (607) 299-7116

2517 Vestal Pkwy E
Vestal, NY 13850
Phone (607) 798-1452

1 Guthrie Sq
Sayre, PA 18840
Phone (570) 887-3106

Interoperability endpoints

  • Direct secure messaging: pheavner153232@direct-guthrie.org

Organizations & group practices 8

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

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

{
    "created_epoch": "1146441600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1614816000000",
    "number": "1093773111",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1 GUTHRIE SQ",
            "city": "SAYRE",
            "state": "PA",
            "postal_code": "188401625",
            "telephone_number": "570-888-5858"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1 GUTHRIE SQ",
            "city": "SAYRE",
            "state": "PA",
            "postal_code": "188401625",
            "telephone_number": "570-888-5858"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1 Atwell Rd",
            "address_purpose": "LOCATION",
            "city": "Cooperstown",
            "state": "NY",
            "postal_code": "133261301",
            "country_code": "US",
            "telephone_number": "607-547-7980",
            "fax_number": "607-547-6782",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "HEAVNER",
        "first_name": "PHILIP",
        "middle_name": "A",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-05-01",
        "last_updated": "2021-03-04",
        "certification_date": "2021-03-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "NY",
            "license": "234803",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "02657225",
            "state": "NY"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "pheavner153232@direct-guthrie.org",
            "affiliation": "N",
            "use": "DIRECT",
            "useDescription": "Direct",
            "address_1": "1 Guthrie Sq",
            "city": "Sayre",
            "state": "PA",
            "country_code": "US",
            "postal_code": "188401625",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Sayre, PA

Sources for this page

Verify at the official NPI Registry.