Individual provider Active NPI

Royce Lee Heffington Jr., PA-C

  • Physician Assistant
  • Prescott Valley, AZ
National Provider Identifier
1306014626
Registry record updated Nov 21, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
10883 Issued in AZ
Practice address
3200 N Windsong Dr
Prescott Valley, AZ 86314-2255
Phone
(866) 974-2673
Fax
(866) 939-2673
NPI assigned
Feb 20, 2008
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 21, 2024

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Surgical Physician Assistant 363AS0400X PA19587 CA
Physician Assistant 363A00000X 10883 AZ Primary

Addresses

Primary practice location

3200 N Windsong Dr
Prescott Valley, AZ 86314-2255

Mailing address

18444 N 25TH Ave Ste 310
Phoenix, AZ 85023-1266
Phone (866) 974-2673

Other practice location 1

10 Harris Ct Bldg A
Suite A1
Monterey, CA 93940-5704
Phone (831) 643-9788

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA, AZ2 enrollments
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 2

Enrollment IDStateProvider typePAC IDDetails
I20080722000555 CA Practitioner - Physician Assistant 4486727518 Reassigns benefits to 2 organizations
I20241210001182 AZ Practitioner - Physician Assistant 4486727518 Reassigns benefits to 1 organization

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
19587CAMDEmergency Medicine Physician
10883AZMDPhysician Assistant
PA19587CAMDSurgical Physician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Svmhs Clinics CurrentSince Jun 10, 2018 Accepting new patients
Center for Orthopedic Research and Educatoin CurrentSince Jan 1, 2025 Accepting new patients
Center for Orthopedic Research and Education, LLC Physician Assistant Past Accepting new patients
Lancelot O Alexander MD a Medical Corporation Past Accepting new patients

Locations

1840 N Jasper Dr
Ste 2
Flagstaff, AZ 86001
Phone (928) 226-2900

18444 N 25th Ave
Ste 210
Phoenix, AZ 85023
Phone (669) 742-6738

18444 N 25th Ave
Ste 310
Phoenix, AZ 85023
Phone (623) 241-8706

3200 N Windsong Dr
Prescott Vly, AZ 86314
Phone (928) 226-2900

10494 W Thunderbird Blvd
Ste 102
Sun City, AZ 85351
Phone (623) 975-8311

850 5th St
Gonzales, CA 93926
Phone (831) 657-3601

1033 Los Palos Dr
Salinas, CA 93901
Phone (831) 424-2866

Organizations & group practices 5

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": "1203465600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1732147200000",
    "number": "1306014626",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "18444 N 25TH AVE STE 310",
            "city": "PHOENIX",
            "state": "AZ",
            "postal_code": "850231266",
            "telephone_number": "866-974-2673",
            "fax_number": "866-939-2673"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3200 N WINDSONG DR",
            "city": "PRESCOTT VALLEY",
            "state": "AZ",
            "postal_code": "863142255",
            "telephone_number": "866-974-2673",
            "fax_number": "866-939-2673"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "10 Harris Ct Bldg A",
            "address_2": "Suite A1",
            "address_purpose": "LOCATION",
            "city": "Monterey",
            "state": "CA",
            "postal_code": "939405704",
            "country_code": "US",
            "telephone_number": "831-643-9788",
            "fax_number": "831-657-0161",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "HEFFINGTON",
        "first_name": "ROYCE",
        "middle_name": "LEE",
        "name_suffix": "Jr.",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2008-02-20",
        "last_updated": "2024-11-21",
        "certification_date": "2024-11-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AS0400X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Surgical",
            "state": "CA",
            "license": "PA19587",
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "AZ",
            "license": "10883",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Prescott Valley, AZ

Sources for this page

Verify at the official NPI Registry.