Individual provider Active NPI

Carolyn Heins

  • Family Medicine Physician
  • Albany, NY
National Provider Identifier
1447604202
Registry record updated May 27, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
299061 Issued in NY
Practice address
391 Myrtle Ave Ste 4a
Albany, NY 12208-3797
Phone
(518) 207-2273
Fax
(518) 207-2293
NPI assigned
Apr 19, 2016
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 27, 2021

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Hospitalist Physician 208M00000X 299061 NY
Family Medicine Physician 207Q00000X 299061 NY Primary

Addresses

Primary practice location

391 Myrtle Ave Ste 4a
Albany, NY 12208-3797

Mailing address

711 Troy Schenectady Rd Ste 203
Latham, NY 12110-2461
Phone (518) 782-3700

Other practice location 1

2215 Burdett Ave
Troy, NY 12180-2466
Phone (518) 271-3300

Other practice location 2

600 Northern Blvd
Albany, NY 12204-1004
Phone (518) 471-3221

Other practice location 3

315 S Manning Blvd
Albany, NY 12208-1707
Phone (518) 525-1550

Other names 1

  • Carolyn Ellsworth Former name

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address payer.credentialing@sphp.com Direct

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20210617000196 CT Practitioner - Family Practice 2163757568 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Lake Erie College of Osteopathic Medicine, Erie, 2016
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Northeast Medical Group IncGroup PAC ID 1254233836, 1,357 clinicians

Practice addresses (Care Compare)

5520 Park Ave
Suite 101
Trumbull, CT 06611-3466
Phone (203) 371-5873

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
100 of 100Reported as apm
Quality
86.54
Promoting interoperability
99.98
Improvement activities
40

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Northeast Medical Group, Inc. CurrentSince Dec 4, 2023 Accepting new patients
Optimus Health Care Inc CurrentSince Jun 2, 2021 Accepting new patients
Mill Hill Medical Consultants Inc CurrentSince Dec 4, 2023 Accepting new patients

Locations

64 Black Rock Ave
Bridgeport, CT 06605
Phone (203) 579-5000

982 E Main St
Bridgeport, CT 06608
Phone (203) 696-3260

471 Barnum Ave
Bridgeport, CT 06608
Phone (203) 333-6864

2800 Main St
Bridgeport, CT 06606
Phone (203) 386-0366

95 Armory Rd
Stratford, CT 06614
Phone (203) 384-3388

5520 Park Ave
Ste 101
Trumbull, CT 06611
Phone (203) 371-5873

5520 Park Ave
Trumbull, CT 06611
Phone (203) 334-7400

Interoperability endpoints

  • Direct secure messaging: cheins639089@direct.ynhh.org

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 4

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": "1461024000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1622073600000",
    "number": "1447604202",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "711 TROY SCHENECTADY RD STE 203",
            "city": "LATHAM",
            "state": "NY",
            "postal_code": "121102461",
            "telephone_number": "518-782-3700",
            "fax_number": "518-782-3799"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "391 MYRTLE AVE STE 4A",
            "city": "ALBANY",
            "state": "NY",
            "postal_code": "122083797",
            "telephone_number": "518-207-2273",
            "fax_number": "518-207-2293"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2215 Burdett Ave",
            "address_purpose": "LOCATION",
            "city": "Troy",
            "state": "NY",
            "postal_code": "121802466",
            "country_code": "US",
            "telephone_number": "518-271-3300",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "600 Northern Blvd",
            "address_purpose": "LOCATION",
            "city": "Albany",
            "state": "NY",
            "postal_code": "122041004",
            "country_code": "US",
            "telephone_number": "518-471-3221",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "315 S Manning Blvd",
            "address_purpose": "LOCATION",
            "city": "Albany",
            "state": "NY",
            "postal_code": "122081707",
            "country_code": "US",
            "telephone_number": "518-525-1550",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "HEINS",
        "first_name": "CAROLYN",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2016-04-19",
        "last_updated": "2021-05-27",
        "certification_date": "2021-05-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208M00000X",
            "taxonomy_group": "",
            "desc": "Hospitalist",
            "state": "NY",
            "license": "299061",
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "NY",
            "license": "299061",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "payer.credentialing@sphp.com",
            "affiliation": "N",
            "endpointDescription": "SPHP Payer Credentialing",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "CCD",
            "address_1": "315 S Manning Blvd",
            "city": "Albany",
            "state": "NY",
            "country_code": "US",
            "postal_code": "122081707",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "first_name": "CAROLYN",
            "last_name": "ELLSWORTH",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Albany, NY

Sources for this page

Verify at the official NPI Registry.