Individual provider Active NPI

Madison Heaton

  • Occupational Therapist
  • South Bend, IN
National Provider Identifier
1164296745
Registry record updated Apr 9, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Occupational TherapistTaxonomy code 225X00000X
License
31008690A Issued in IN
Practice address
20531 Darden Rd
South Bend, IN 46637-2915
Phone
(574) 272-0100
NPI assigned
Nov 14, 2023
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 9, 2025

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Occupational Therapist 225X00000X 46TR01141200 NJ
Occupational Therapist 225X00000X 072.0134420 VT
Occupational Therapist 225X00000X 31008690A IN Primary

Addresses

Primary practice location

20531 Darden Rd
South Bend, IN 46637-2915

Mailing address

189 Wabeeno TRL
Medford Lakes, NJ 08055-1319
Phone (609) 678-5808

Other practice location 1

105 Chester Rd
Springfield, VT 05156-2106
Phone (802) 885-5741

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20240913000014 TX Practitioner - Occupational Therapist in Private Practice 1658811930 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
31008690AINMDOccupational Therapist
46TR01141200NJMDOccupational Therapist
072.0134420VTMDOccupational Therapist

Practice roles

OrganizationSpecialtyStatusNew patients
Synergy Care Southeast, LLC Occupational Therapist CurrentSince Aug 1, 2024 Accepting new patients

Locations

127 W Broad St
Ste 850
Lake Charles, LA 70601
Phone (337) 310-8500

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": "1699920000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1744156800000",
    "number": "1164296745",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "189 WABEENO TRL",
            "city": "MEDFORD LAKES",
            "state": "NJ",
            "postal_code": "080551319",
            "telephone_number": "609-678-5808"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "20531 DARDEN RD",
            "city": "SOUTH BEND",
            "state": "IN",
            "postal_code": "466372915",
            "telephone_number": "574-272-0100"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "105 Chester Rd",
            "address_purpose": "LOCATION",
            "city": "Springfield",
            "state": "VT",
            "postal_code": "051562106",
            "country_code": "US",
            "telephone_number": "802-885-5741",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "HEATON",
        "first_name": "MADISON",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2023-11-14",
        "last_updated": "2025-04-09",
        "certification_date": "2025-03-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225X00000X",
            "taxonomy_group": "",
            "desc": "Occupational Therapist",
            "state": "NJ",
            "license": "46TR01141200",
            "primary": false
        },
        {
            "code": "225X00000X",
            "taxonomy_group": "",
            "desc": "Occupational Therapist",
            "state": "VT",
            "license": "072.0134420",
            "primary": false
        },
        {
            "code": "225X00000X",
            "taxonomy_group": "",
            "desc": "Occupational Therapist",
            "state": "IN",
            "license": "31008690A",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in South Bend, IN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 9, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.