NPIMap

Individual provider Active NPI

Kristin K Heitman, CRNA

  • Anesthesiology Physician
  • Conway, AR
National Provider Identifier
1497053433
Registry record updated Jun 1, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Anesthesiology PhysicianTaxonomy code 207L00000X
License
147446-30 Issued in WI
Practice address
2425 Prince St Ste 4
Conway, AR 72034-3701
Phone
(501) 327-6665
NPI assigned
Feb 28, 2011
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 1, 2016

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Anesthesiology Physician 207L00000X 147446-30 WI Primary

Addresses

Primary practice location

2425 Prince St Ste 4
Conway, AR 72034-3701

Mailing address

1770 Hudson Loop Rd
Conway, AR 72034-8295

Other identifiers 1

IdentifierTypeStateIssuer
147446-30OtherWILICENSE

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WI

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20110601000508 WI Practitioner - Certified Registered Nurse Anesthetist (Crna) 4183801079 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Certified Registered Nurse Anesthetist (Crna)
Education
Other, 2011
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Association of Hospital Anesthesiologists SCGroup PAC ID 3476539875, 84 clinicians

Practice addresses (Care Compare)

1818 N Meade St
Appleton, WI 54911-3454
Phone (920) 731-4101

Hospital & facility affiliations

  • Thedacare Regional Medical Center - Appleton Inc Hospital, Appleton, WI, CCN 520160

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Certified Registered Nurse

State licenses

LicenseStateTypeSpecialty
147446-30WIMDAnesthesiology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Association of Hospital Anesthesiologists SC Anesthesiology CurrentSince Feb 26, 2018 Accepting new patients
Bellin Anesthesia Associates, S.C. Anesthesiology Past Accepting new patients
Wisconsin Institute of Urology SC Past Accepting new patients
Conway Regional Medical Center Inc PastSince Aug 31, 2015 Accepting new patients

Locations

1818 N Meade St
Appleton, WI 54911
Phone (920) 731-4101

2109 E Capitol Dr
#B
Appleton, WI 54911
Phone (844) 693-1483

130 2nd St
Neenah, WI 54956
Phone (920) 729-2063

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 7

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": "1298851200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1464739200000",
    "number": "1497053433",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1770 HUDSON LOOP RD",
            "city": "CONWAY",
            "state": "AR",
            "postal_code": "720348295"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2425 PRINCE ST STE 4",
            "city": "CONWAY",
            "state": "AR",
            "postal_code": "720343701",
            "telephone_number": "501-327-6665"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HEITMAN",
        "first_name": "KRISTIN",
        "middle_name": "K",
        "credential": "CRNA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2011-02-28",
        "last_updated": "2016-06-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207L00000X",
            "taxonomy_group": "",
            "desc": "Anesthesiology",
            "state": "WI",
            "license": "147446-30",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "LICENSE",
            "identifier": "147446-30",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Conway, AR

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 1, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.