Individual provider Active NPI

Robert Paul Heck, PH.D

  • Psychologist
  • Fort Wayne, IN
National Provider Identifier
1386711984
Registry record updated Jan 14, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
PsychologistTaxonomy code 103T00000X
License
2004-1203A Issued in IN
Practice address
10315 Dawsons Creek Blvd
Suite F
Fort Wayne, IN 46825-1912
Phone
(260) 387-6340
NPI assigned
Nov 29, 2006
Last updated
Jan 14, 2016By the provider in NPPES
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jan 14, 2016

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Psychologist 103T00000X 2004-1203A IN Primary
Psychologist 103T00000X 5386 OH

Addresses

Primary practice location

10315 Dawsons Creek Blvd
Suite F
Fort Wayne, IN 46825-1912

Mailing address

10315 Dawsons Creek Blvd
Suite F
Fort Wayne, IN 46825-1912
Phone (260) 387-6340

Other identifiers 3

IdentifierTypeStateIssuer
200984000OtherINMAGELLAN BEHAVIORAL
000-000-175-606OtherINBC-BS NON-PAR
000-777-2138OtherINAETNA NON-PAR

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OH, IN2 enrollments
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: No
  • Power mobility devices: No
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20080422000237 OH Practitioner - Clinical Psychologist 6709964406 Reassigns benefits to 1 organization
I20090225000279 IN Practitioner - Clinical Psychologist 6709964406 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Clinical Psychologist
Education
West Virginia University School of Medicine, 1997
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services

Practice addresses (Care Compare)

1030 W Wayne St
Paulding, OH 45879-1545
Phone 2603876340105

10315 Dawsons Creek Blvd
Suite F
Ft Wayne, IN 46825-1912

10315 Dawsons Creek Blvd F
Fort Wayne, IN 46825-1912

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled
HHS exclusion list flag
CMS’s directory marks this NPI as on an HHS exclusion list; no matching OIG record was found. The OIG exclusions file (LEIE) holds no record for this NPI, and the directory does not say which list the flag comes from. How exclusions are shown Confirm with the OIG exclusions search.
Credentials
Doctor of Philosophy

State licenses

LicenseStateTypeSpecialty
2004-1203AINMDPsychologist
5386OHMDPsychologist

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1164758400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1452729600000",
    "number": "1386711984",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10315 DAWSONS CREEK BLVD",
            "address_2": "SUITE F",
            "city": "FORT WAYNE",
            "state": "IN",
            "postal_code": "468251912",
            "telephone_number": "260-387-6340"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10315 DAWSONS CREEK BLVD",
            "address_2": "SUITE F",
            "city": "FORT WAYNE",
            "state": "IN",
            "postal_code": "468251912",
            "telephone_number": "260-387-6340"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HECK",
        "first_name": "ROBERT",
        "middle_name": "PAUL",
        "name_prefix": "Dr.",
        "credential": "PH.D",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-11-29",
        "last_updated": "2016-01-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103T00000X",
            "taxonomy_group": "",
            "desc": "Psychologist",
            "state": "IN",
            "license": "2004-1203A",
            "primary": true
        },
        {
            "code": "103T00000X",
            "taxonomy_group": "",
            "desc": "Psychologist",
            "state": "OH",
            "license": "5386",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MAGELLAN BEHAVIORAL",
            "identifier": "200984000",
            "state": "IN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BC-BS NON-PAR",
            "identifier": "000-000-175-606",
            "state": "IN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AETNA NON-PAR",
            "identifier": "000-777-2138",
            "state": "IN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Fort Wayne, IN

Sources for this page

Verify at the official NPI Registry.