Active NPI
Robert Heist, DDS
- Dentist
- Clackamas, OR
National Provider Identifier
1376654905
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- D8746
- Practice address
- 9775 SE Sunnyside Rd
200
Clackamas, OR 97015-5739 - Phone
- (503) 655-8471
- Fax
- (503) 723-4907
- NPI assigned
- Aug 31, 2006
- 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 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | 30015652 | OH | |
| Dentist | 122300000X | D8746 | OR | Primary |
Addresses
Primary practice location
9775 SE Sunnyside Rd
200
Clackamas, OR 97015-5739
Mailing address
2051 Kaen Rd
367
Oregon City, OR 97045-4035
Phone (503) 650-3110
Other identifiers 4
| Identifier | Type | State | Issuer |
|---|---|---|---|
| D8746 | Other | OR | STATE LICENCE NUMBER |
| 099071 | Medicaid | OH | |
| R103163 | Other | MEDICARE PART B | |
| 168395 | Medicaid | OR |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in OR
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: No
- Hospice: Yes
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20170424001425 | OR | Order and Referring Only - Dentist | 4688950819 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 30015652 | OH | MD | Dentist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1156982400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1488240000000",
"number": "1376654905",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2051 KAEN RD",
"address_2": "367",
"city": "OREGON CITY",
"state": "OR",
"postal_code": "970454035",
"telephone_number": "503-650-3110",
"fax_number": "503-742-5979"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "9775 SE SUNNYSIDE RD",
"address_2": "200",
"city": "CLACKAMAS",
"state": "OR",
"postal_code": "970155739",
"telephone_number": "503-655-8471",
"fax_number": "503-723-4907"
}
],
"practiceLocations": [],
"basic": {
"last_name": "HEIST",
"first_name": "ROBERT",
"name_prefix": "Dr.",
"credential": "DDS",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-08-31",
"last_updated": "2017-02-28",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "OH",
"license": "30015652",
"primary": false
},
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "OR",
"license": "D8746",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "STATE LICENCE NUMBER",
"identifier": "D8746",
"state": "OR"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "099071",
"state": "OH"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MEDICARE PART B",
"identifier": "R103163",
"state": null
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "168395",
"state": "OR"
}
],
"endpoints": [],
"other_names": []
}Other providers in Clackamas, OR
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 28, 2017; 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.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.