Chad Hetherwick, MS, RDN

Primary specialty

Registered DietitianTaxonomy code 133V00000X

License

960912

Practice address

8508 N Prairie VW
Prescott Valley, AZ 86315-9089

Phone

(928) 772-8652

Fax

(928) 772-8078

NPI assigned

Jun 27, 2007

Sex

Male

Sole proprietor

No

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

Specialties & licenses 4

Addresses

Medicare fee-for-service enrollment

Enrolled in AZ

Enrollment records 1

Specialty

Registered Dietitian Or Nutrition Professional

Education

Other, 2004

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Group practices

Prairie View Creations LLCGroup PAC ID 8022420066, 2 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Master of Science

Practice roles

Locations

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.

• Prairie View Creations LLC

  • Registered Dietitian
  • Prescott Valley, AZ
  • NPI 1063979961

  Dietitian, Registered

  Medicare reassignment Care Compare group NPD Authorized official
• Yavapai Community Hospital Association

  • General Acute Care Hospital
  • Prescott, AZ
  • NPI 1902897820
  Medicare reassignment NPD
• Yavapai Pathology Associates PLC

  • Anatomic Pathology Physician
  • Prescott, AZ
  • NPI 1841234184
  NPD
• Yrmc Hospice

  • Community Based Hospice Care Agency
  • Prescott Valley, AZ
  • NPI 1467409219
  NPD
• Verde Valley Medical Center

  • General Acute Care Hospital
  • Cottonwood, AZ
  • NPI 1346291648
  NPD (past)

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

{
    "created_epoch": "1182902400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1604361600000",
    "number": "1104023969",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 10214",
            "city": "PRESCOTT",
            "state": "AZ",
            "postal_code": "863040214",
            "telephone_number": "928-772-8652",
            "fax_number": "928-772-8078"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8508 N PRAIRIE VW",
            "city": "PRESCOTT VALLEY",
            "state": "AZ",
            "postal_code": "863159089",
            "telephone_number": "928-772-8652",
            "fax_number": "928-772-8078"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HETHERWICK",
        "first_name": "CHAD",
        "credential": "MS, RDN",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-06-27",
        "last_updated": "2020-11-03",
        "certification_date": "2020-11-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "133VN1004X",
            "taxonomy_group": "",
            "desc": "Dietitian, Registered, Nutrition, Pediatric",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "133VN1005X",
            "taxonomy_group": "",
            "desc": "Dietitian, Registered, Nutrition, Renal",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "133VN1006X",
            "taxonomy_group": "",
            "desc": "Dietitian, Registered, Nutrition, Metabolic",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "133V00000X",
            "taxonomy_group": "",
            "desc": "Dietitian, Registered",
            "state": null,
            "license": "960912",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Highland Dental,PLLC

• Registered Dietitian in Prescott Valley, AZ
• Providers in Prescott Valley, AZ by specialty
• Registered Dietitian in Arizona

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 3, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.