Individual provider Active NPI

Mark Steven Heil, D.O.

  • Chiropractor
  • Anoka, MN
National Provider Identifier
1104918341
Registry record updated Jul 8, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
ChiropractorTaxonomy code 111N00000X
License
2695 Issued in MN
Practice address
3507 Round Lake Blvd NW
Suite 300
Anoka, MN 55303-5001
Phone
(763) 323-4855
Fax
(763) 427-4822
NPI assigned
Sep 28, 2006
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jul 8, 2007

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Chiropractor 111N00000X 2695 MN Primary

Addresses

Primary practice location

3507 Round Lake Blvd NW
Suite 300
Anoka, MN 55303-5001

Mailing address

3507 Round Lake Blvd NW
Suite 300
Anoka, MN 55303-5001
Phone (763) 323-4855

Other identifiers 1

IdentifierTypeStateIssuer
4C686HEOtherMNBLUE CROSS BLUE SHIELD

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MN

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20050607000806 MN Practitioner - Chiropractic 1355384686 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Chiropractic
Education
Northwestern College of Chiropractic, 1989
Medicare assignment
Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

13849 Round Lake Blvd NW
Andover, MN 55304-3664
Phone (763) 323-4855

National Provider Directory

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

Organizations & group practices 1

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": "1159401600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1104918341",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3507 ROUND LAKE BLVD NW",
            "address_2": "SUITE 300",
            "city": "ANOKA",
            "state": "MN",
            "postal_code": "553035001",
            "telephone_number": "763-323-4855",
            "fax_number": "763-427-4822"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3507 ROUND LAKE BLVD NW",
            "address_2": "SUITE 300",
            "city": "ANOKA",
            "state": "MN",
            "postal_code": "553035001",
            "telephone_number": "763-323-4855",
            "fax_number": "763-427-4822"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HEIL",
        "first_name": "MARK",
        "middle_name": "STEVEN",
        "credential": "D.O.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-09-28",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "",
            "desc": "Chiropractor",
            "state": "MN",
            "license": "2695",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD",
            "identifier": "4C686HE",
            "state": "MN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Anoka, MN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; 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.