Individual provider Active NPI

Heather Brock, CRNP

  • Gerontology Nurse Practitioner
  • Phila, PA
National Provider Identifier
1508230582
Registry record updated Jan 17, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Gerontology Nurse PractitionerTaxonomy code 363LG0600X
License
SP015633 Issued in PA
Practice address
909 Walnut St
Dept of Neurological Surgery
Phila, PA 19107-5211
Phone
(610) 800-1261
NPI assigned
Nov 13, 2015
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 17, 2018

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Acute Care Nurse Practitioner 363LA2100X SP015633 PA
Gerontology Nurse Practitioner 363LG0600X SP015633 PA Primary

Addresses

Primary practice location

909 Walnut St
Dept of Neurological Surgery
Phila, PA 19107-5211

Mailing address

61 Concord Rd
Aston, PA 19014-2902

Other names 1

  • Heather May Former name

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20160404000136 PA Practitioner - Nurse Practitioner 3678870847 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2015
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Jefferson University PhysiciansGroup PAC ID 7911819180, 1,528 clinicians

Practice addresses (Care Compare)

900 Walnut St 2ND Floor
Jeff Hosp for Neuro
Philadelphia, PA 19107-5191
Phone (215) 955-1234

Hospital & facility affiliations

  • Thomas Jefferson University Hospital Hospital, Philadelphia, PA, CCN 390174

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Jefferson University Physicians CurrentSince Jan 23, 2016 Accepting new patients
Jefferson University Physicians Past Accepting new patients

Locations

900 Walnut St
Fl 2
Philadelphia, PA 19107
Phone (215) 955-1234

925 Chestnut St
Fl 6
Philadelphia, PA 19107
Phone (215) 955-6760

909 Walnut St
#2
Philadelphia, PA 19107
Phone (215) 955-7000

909 Walnut St
Philadelphia, PA 19107
Phone (215) 503-7008

Organizations & group practices 2

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": "1447372800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1516147200000",
    "number": "1508230582",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "61 CONCORD RD",
            "city": "ASTON",
            "state": "PA",
            "postal_code": "190142902"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "909 WALNUT ST",
            "address_2": "DEPT OF NEUROLOGICAL SURGERY",
            "city": "PHILA",
            "state": "PA",
            "postal_code": "191075211",
            "telephone_number": "610-800-1261"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BROCK",
        "first_name": "HEATHER",
        "credential": "CRNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2015-11-13",
        "last_updated": "2018-01-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LA2100X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Acute Care",
            "state": "PA",
            "license": "SP015633",
            "primary": false
        },
        {
            "code": "363LG0600X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Gerontology",
            "state": "PA",
            "license": "SP015633",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "HEATHER",
            "last_name": "MAY",
            "credential": "CRNP",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Phila, PA

Sources for this page

Verify at the official NPI Registry.