Active NPI
Jonathan W Heusel, MD
- Molecular Genetic Pathology (Pathology) Physician
- Saint Louis, MO
National Provider Identifier
1255329058
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Molecular Genetic Pathology (Pathology) Physician
- License
- 108616
- Practice address
- 4320 Forest Park Ave
Ste 209
Saint Louis, MO 63108-2979 - Phone
- (314) 362-5641
- Fax
- (314) 362-0369
- NPI assigned
- Oct 6, 2005
- 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 |
|---|---|---|---|---|
| Molecular Genetic Pathology (Pathology) Physician | 207ZP0007X | 108616 | MO | Primary |
Addresses
Primary practice location
4320 Forest Park Ave
Ste 209
Saint Louis, MO 63108-2979
Mailing address
660 S Euclid Ave
CB 8118
Saint Louis, MO 63110-1010
Phone (314) 362-5641
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1043414113 | Medicaid | MO |
Electronic endpoints 1
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| FHIR URL | https://epicproxy.et0965.epichosted.com/FHIRProxy/api/FHIR/DSTU2/ | Washington University |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in NY
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: Yes
Enrollment records 1
Care Compare profile
Medicare Care Compare- Specialty
- Pathology
- Education
- Washington University School of Medicine, 1995
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
Practice addresses (Care Compare)
100 Nicolls Rd
Stony Brook, NY 11790-3407
Phone (631) 444-2222
Hospital & facility affiliations
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 108616 | MO | MD | Molecular Genetic Pathology (Pathology) Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Stony Brook Pathologists, University Faculty Practice Corporation | Current | Accepting new patients |
Locations
100 Nicolls Rd
Stony Brook, NY 11790
Phone (631) 444-1069
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.
-
- Anatomic Pathology & Clinical Pathology Physician
- Stony Brook, NY
- NPI 1912944794
Hospital & facility affiliations 6
Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.
-
- General Acute Care Hospital
- Southampton, NY
- NPI 1033224704
-
- General Acute Care Hospital
- Southampton, NY
- NPI 1225507114
-
- General Acute Care Hospital
- Greenport, NY
- NPI 1881690691
-
- General Acute Care Hospital
- Stony Brook, NY
- NPI 1972523348
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1128556800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1636934400000",
"number": "1255329058",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "660 S EUCLID AVE",
"address_2": "CB 8118",
"city": "SAINT LOUIS",
"state": "MO",
"postal_code": "631101010",
"telephone_number": "314-362-5641",
"fax_number": "314-362-0369"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4320 FOREST PARK AVE",
"address_2": "STE 209",
"city": "SAINT LOUIS",
"state": "MO",
"postal_code": "631082979",
"telephone_number": "314-362-5641",
"fax_number": "314-362-0369"
}
],
"practiceLocations": [],
"basic": {
"last_name": "HEUSEL",
"first_name": "JONATHAN",
"middle_name": "W",
"name_prefix": "Dr.",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2005-10-06",
"last_updated": "2021-11-15",
"status": "A"
},
"taxonomies": [
{
"code": "207ZP0007X",
"taxonomy_group": "",
"desc": "Pathology, Molecular Genetic Pathology",
"state": "MO",
"license": "108616",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "1043414113",
"state": "MO"
}
],
"endpoints": [
{
"endpointType": "FHIR",
"endpointTypeDescription": "FHIR URL",
"endpoint": "https://epicproxy.et0965.epichosted.com/FHIRProxy/api/FHIR/DSTU2/",
"affiliation": "Y",
"affiliationName": "Washington University",
"address_1": "4320 Forest Park Ave",
"address_2": "Ste 209",
"city": "Saint Louis",
"state": "MO",
"country_code": "US",
"postal_code": "631082979",
"country_name": "United States",
"address_type": "DOM"
}
],
"other_names": []
}Other providers in Saint Louis, MO
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 15, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- 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.