Individual provider Active NPI

Heather C Upchurch, PA-C

  • Medical Physician Assistant
  • Crown Point, IN
National Provider Identifier
1104869569
Registry record updated Jun 27, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Medical Physician AssistantTaxonomy code 363AM0700X
License
10000889A Issued in IN
Practice address
70 W 94TH Place
Crown Point, IN 46307-1710
Phone
(219) 662-8822
Fax
(219) 662-8833
NPI assigned
Jun 14, 2006
Last updated
Jun 27, 2025By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 27, 2025

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Medical Physician Assistant 363AM0700X 10000889A IN Primary

Addresses

Primary practice location

70 W 94TH Place
Crown Point, IN 46307-1710

Mailing address

801 York St
Manitowoc, WI 54220-4630
Phone (920) 663-9008

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address HU4583@forefrontdermatology.emadirect.md

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IN
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20070412000453 IN Practitioner - Physician Assistant 6507878782 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 1998
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Forefront Dermatology SCGroup PAC ID 3779471701, 650 clinicians

Practice addresses (Care Compare)

303 S Walnut St
Seymour, IN 47274-2368
Phone (812) 358-7705

70 W 94TH PL
Crown Point, IN 46307-1710
Phone (219) 662-8822

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
97.45 of 100Reported as group
Promoting interoperability
97
Improvement activities
40

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

State licenses

LicenseStateTypeSpecialty
10000889AINMDMedical Physician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Forefront Dermatology, S.C. CurrentSince Jan 15, 2019 Accepting new patients
Forefront Dermatology, S.C. CurrentSince Jan 15, 2019 Accepting new patients
Forefront Dermatology, S.C. Past Accepting new patients

Locations

70 W 94th Pl
Crown Point, IN 46307
Phone (219) 662-8822

70 W 94th Pl
#O
Crown Point, IN 46307
Phone (219) 662-8856

303 S Walnut St
Seymour, IN 47274
Phone (812) 358-7705

801 York St
Manitowoc, WI 54220
Phone (866) 630-9882

Interoperability endpoints

  • Direct secure messaging: hu4583@forefrontdermatology.emadirect.md

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 2

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1150243200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1750982400000",
    "number": "1104869569",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "801 YORK ST",
            "city": "MANITOWOC",
            "state": "WI",
            "postal_code": "542204630",
            "telephone_number": "920-663-9008",
            "fax_number": "920-684-1439"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "70 W 94TH PLACE",
            "city": "CROWN POINT",
            "state": "IN",
            "postal_code": "463071710",
            "telephone_number": "219-662-8822",
            "fax_number": "219-662-8833"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "UPCHURCH",
        "first_name": "HEATHER",
        "middle_name": "C",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-06-14",
        "last_updated": "2025-06-27",
        "certification_date": "2025-06-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "IN",
            "license": "10000889A",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "HU4583@forefrontdermatology.emadirect.md",
            "affiliation": "N",
            "address_1": "70 W 94th Place",
            "city": "Crown Point",
            "state": "IN",
            "country_code": "US",
            "postal_code": "463071710",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Crown Point, IN

Sources for this page

Verify at the official NPI Registry.