Individual provider Active NPI

Jennifer Rebecca Heimall, MD

  • Pediatric Allergy/Immunology Physician
  • Philadelphia, PA
National Provider Identifier
1104023316
Registry record updated Apr 15, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatric Allergy/Immunology PhysicianTaxonomy code 2080P0201X
License
MD440044 Issued in PA
Practice address
3550 Market St FL 3
Childrens Hospital of Philadelphia - Allergy and Immun
Philadelphia, PA 19104-3365
Phone
(215) 590-2549
Fax
(215) 590-4529
NPI assigned
Jun 29, 2007
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 15, 2013

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

Specialties & licenses 5

Specialty (taxonomy)CodeLicenseStatePrimary
Allergy & Immunology Physician 207K00000X MD440044 PA
Allergy & Immunology (Internal Medicine) Physician 207RA0201X 25MA07835700 NJ
Pediatrics Physician 208000000X 25MA07835700 NJ
Pediatrics Physician 208000000X MD440044 PA
Pediatric Allergy/Immunology Physician 2080P0201X MD440044 PA Primary

Addresses

Primary practice location

3550 Market St FL 3
Childrens Hospital of Philadelphia - Allergy and Immun
Philadelphia, PA 19104-3365

Mailing address

100 E Penn SQ
9TH Floor
Philadelphia, PA 19107-3323
Phone (267) 425-9234

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in PA
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
I20100817001364 PA Practitioner - Allergy/Immunology 1658405386 Reassigns benefits to 1 organization

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
25MA07835700NJMDAllergy & Immunology (Internal Medicine) Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Childrens Health Care Associates, Inc Pediatric Allergy/Immunology CurrentSince Jul 1, 2010 Accepting new patients
Childrens Health Care Associates, Inc Pediatrics Current Accepting new patients
Childen'S Health Care Associates Inc. CurrentSince Jul 1, 2010 Accepting new patients
Childrens Health Care Associates of New Jersey PC Pediatrics Past Accepting new patients

Locations

100 E Penn Sq
Fl 9
Philadelphia, PA 19107
Phone (267) 425-9232

3500 Civic Center Blvd
Philadelphia, PA 19104
Phone (215) 590-2169

3550 Market St
Fl 3
Philadelphia, PA 19104
Phone (215) 590-2549

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.

NPI Registry JSON

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

{
    "created_epoch": "1183075200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1365984000000",
    "number": "1104023316",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "100 E PENN SQ",
            "address_2": "9TH FLOOR",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "191073323",
            "telephone_number": "267-425-9234",
            "fax_number": "267-425-9299"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3550 MARKET ST FL 3",
            "address_2": "CHILDRENS HOSPITAL OF PHILADELPHIA - ALLERGY AND IMMUN",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "191043365",
            "telephone_number": "215-590-2549",
            "fax_number": "215-590-4529"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HEIMALL",
        "first_name": "JENNIFER",
        "middle_name": "REBECCA",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-06-29",
        "last_updated": "2013-04-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207K00000X",
            "taxonomy_group": "",
            "desc": "Allergy & Immunology",
            "state": "PA",
            "license": "MD440044",
            "primary": false
        },
        {
            "code": "207RA0201X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Allergy & Immunology",
            "state": "NJ",
            "license": "25MA07835700",
            "primary": false
        },
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "NJ",
            "license": "25MA07835700",
            "primary": false
        },
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "PA",
            "license": "MD440044",
            "primary": false
        },
        {
            "code": "2080P0201X",
            "taxonomy_group": "",
            "desc": "Pediatrics, Pediatric Allergy/Immunology",
            "state": "PA",
            "license": "MD440044",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Philadelphia, PA

Sources for this page

Verify at the official NPI Registry.