Individual provider Active NPI

Katherine DO Heidenreich, MD

  • Otolaryngology Physician
  • Ann Arbor, MI
National Provider Identifier
1487746178
Registry record updated May 4, 2009
On this page

Key facts

NPPES NPI Registry
Primary specialty
Otolaryngology PhysicianTaxonomy code 207Y00000X
License
4301089137 Issued in MI
Practice address
1500 East Medical Center Dr
1St Floor Taubman Ctr Recp a
Ann Arbor, MI 48109-5312
Phone
(734) 936-8051
NPI assigned
Sep 29, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 4, 2009

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Otolaryngology Physician 207Y00000X 35088557 OH
Otolaryngology Physician 207Y00000X 4301089137 MI Primary
Otology & Neurotology Physician 207YX0901X 4301089137 MI

Addresses

Primary practice location

1500 East Medical Center Dr
1St Floor Taubman Ctr Recp a
Ann Arbor, MI 48109-5312

Mailing address

3621 S State St
700 KMS Place
Ann Arbor, MI 48108
Phone (734) 936-2047

Other identifiers 1

IdentifierTypeStateIssuer
2684984MedicaidOH

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MI
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
I20090414000560 MI Practitioner - Otolaryngology 0840296851 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Otolaryngology
Education
University of California, San Diego School of Medicine, 2001
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Regents of the University of MichiganGroup PAC ID 3779496856, 3,344 clinicians

Practice addresses (Care Compare)

1500 E Medical Ctr Dr
Ann Arbor, MI 48109-5000
Phone (734) 936-8051

24 Frank Lloyd Wright Dr
Ann Arbor, MI 48105-9484
Phone (734) 936-8051

Hospital & facility affiliations

  • University of Michigan Health System Hospital, Ann Arbor, MI, CCN 230046

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
4301089137MIMDOtolaryngology Physician
35088557OHMDOtolaryngology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Regents of the University of Michigan CurrentSince Apr 1, 2009 Accepting new patients
Regents of the University of Michigan CurrentSince Apr 1, 2009 Accepting new patients
Regents of the University of Michigan Current Accepting new patients
Regents of the University of Michigan Past Accepting new patients

Locations

24 Frank Lloyd Wright Dr
Ann Arbor, MI 48105
Phone (734) 930-7400

3621 S State St
#700
Ann Arbor, MI 48108

1500 E Medical Center Dr
Ann Arbor, MI 48109
Phone (734) 936-4280

1500 E Medical Center Dr
Fl 1
Ann Arbor, MI 48109
Phone (734) 936-4054

19900 Haggerty Rd
Ste 100
Livonia, MI 48152
Phone (248) 432-7801

Interoperability endpoints

  • Direct secure messaging: kheidenreich22289@direct.med.umich.edu

Organizations & group practices 4

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 1

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": "1159488000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1241395200000",
    "number": "1487746178",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3621 S STATE ST",
            "address_2": "700 KMS PLACE",
            "city": "ANN ARBOR",
            "state": "MI",
            "postal_code": "48108",
            "telephone_number": "734-936-2047"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1500 EAST MEDICAL CENTER DR",
            "address_2": "1ST FLOOR TAUBMAN CTR RECP A",
            "city": "ANN ARBOR",
            "state": "MI",
            "postal_code": "481095312",
            "telephone_number": "734-936-8051"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HEIDENREICH",
        "first_name": "KATHERINE",
        "middle_name": "DO",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-09-29",
        "last_updated": "2009-05-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Y00000X",
            "taxonomy_group": "",
            "desc": "Otolaryngology",
            "state": "OH",
            "license": "35088557",
            "primary": false
        },
        {
            "code": "207Y00000X",
            "taxonomy_group": "",
            "desc": "Otolaryngology",
            "state": "MI",
            "license": "4301089137",
            "primary": true
        },
        {
            "code": "207YX0901X",
            "taxonomy_group": "",
            "desc": "Otolaryngology, Otology & Neurotology",
            "state": "MI",
            "license": "4301089137",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2684984",
            "state": "OH"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Ann Arbor, MI

Sources for this page

Verify at the official NPI Registry.