Active NPI
Shawn Heisler
- Physician Assistant
- Fort Carson, CO
National Provider Identifier
1104479542
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physician Assistant
- Practice address
- 1650 Cochrane Cir
Fort Carson, CO 80913-4613 - Phone
- (910) 467-3128
- NPI assigned
- Jul 23, 2019
- 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 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physician Assistant | 363A00000X | Primary |
Addresses
Primary practice location
1650 Cochrane Cir
Fort Carson, CO 80913-4613
Mailing address
1650 Cochrane Cir
Fort Carson, CO 80913-4613
Phone (910) 467-3128
Electronic endpoints 1
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| Other URL | other |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1563840000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1607299200000",
"number": "1104479542",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1650 COCHRANE CIR",
"city": "FORT CARSON",
"state": "CO",
"postal_code": "809134613",
"telephone_number": "910-467-3128"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1650 COCHRANE CIR",
"city": "FORT CARSON",
"state": "CO",
"postal_code": "809134613",
"telephone_number": "910-467-3128"
}
],
"practiceLocations": [],
"basic": {
"last_name": "HEISLER",
"first_name": "SHAWN",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2019-07-23",
"last_updated": "2020-12-07",
"certification_date": "2020-12-07",
"status": "A"
},
"taxonomies": [
{
"code": "363A00000X",
"taxonomy_group": "",
"desc": "Physician Assistant",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [
{
"endpointType": "OTHERS",
"endpointTypeDescription": "Other URL",
"endpoint": "other",
"affiliation": "N",
"address_1": "650 Joel Dr",
"city": "Fort Campbell",
"state": "KY",
"country_code": "US",
"postal_code": "422235318",
"country_name": "United States",
"address_type": "DOM"
}
],
"other_names": []
}Other providers in Fort Carson, CO
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 7, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.