NPIMap

Individual provider Active NPI

Jeannette A Heidlberg, M.D.

  • Internal Medicine Physician
  • Maple Grove, MN
National Provider Identifier
1417198839
Registry record updated Mar 9, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
54935 Issued in MN
Practice address
9555 Upland LN N
Maple Grove, MN 55369-4485
Phone
(952) 993-1440
NPI assigned
Mar 13, 2009
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Mar 9, 2021

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatrics Physician 208000000X 54935 MN
Internal Medicine Physician 207R00000X 54935 MN Primary

Addresses

Primary practice location

9555 Upland LN N
Maple Grove, MN 55369-4485

Mailing address

8170 33Rd Ave S
Bloomington, MN 55425-4516

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MN
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20120914000600 MN Practitioner - Pediatric MedicinePractitioner - Internal Medicine 2365690484 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Pediatric MedicineAlso: Internal Medicine
Education
Medical College of Wisconsin, 2008
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Park Nicollet ClinicGroup PAC ID 7911819438, 1,778 clinicians

Practice addresses (Care Compare)

15111 Twelve Oaks Ctr Dr
Minnetonka, MN 55305-5201
Phone (952) 993-4500

15800 95TH Ave N
Maple Grove, MN 55369-4400
Phone (952) 993-1440

2001 Blaisdell Ave
Minneapolis, MN 55404-2414
Phone (952) 993-8000

5320 Hyland Greens Dr
Bloomington, MN 55437-3934
Phone (952) 993-2400

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
54935MNMDInternal Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Park Nicollet Clinic Pediatrics CurrentSince Aug 6, 2012 Accepting new patients
Park Nicollet Clinic Pediatrics Current Accepting new patients
Maple Grove Hospital Corporation Past Accepting new patients

Locations

15800 95th Ave N
Maple Grove, MN 55369
Phone (952) 993-1400

9555 Upland Ln N
Maple Grove, MN 55369
Phone (952) 993-1440

5320 Hyland Greens Dr
Minneapolis, MN 55437
Phone (952) 993-2400

1415 Saint Francis Ave
Shakopee, MN 55379
Phone (952) 993-7750

Interoperability endpoints

  • Direct secure messaging: jheidlberg44073@direct.healthpartners.com

Organizations & group practices 3

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.

Hospital & facility affiliations 6

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1236902400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1615248000000",
    "number": "1417198839",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8170 33RD AVE S",
            "city": "BLOOMINGTON",
            "state": "MN",
            "postal_code": "554254516"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9555 UPLAND LN N",
            "city": "MAPLE GROVE",
            "state": "MN",
            "postal_code": "553694485",
            "telephone_number": "952-993-1440"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HEIDLBERG",
        "first_name": "JEANNETTE",
        "middle_name": "A",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2009-03-13",
        "last_updated": "2021-03-09",
        "certification_date": "2021-03-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "MN",
            "license": "54935",
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "MN",
            "license": "54935",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Maple Grove, MN

Sources for this page

Verify at the official NPI Registry.