Active NPI
Heather M Porter, PA-C
- Physician Assistant
- Wall Township, NJ
National Provider Identifier
1588700405
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physician Assistant
- License
- 25MP00202900
- Practice address
- 2101 Route 34 Ste D
Wall Township, NJ 07719-9104 - Phone
- (732) 974-0003
- NPI assigned
- Jan 29, 2007
- Last updated
- Jun 15, 2010
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physician Assistant | 363A00000X | 011176 | NY | |
| Physician Assistant | 363A00000X | 25MP00202900 | NJ | Primary |
Addresses
Primary practice location
2101 Route 34 Ste D
Wall Township, NJ 07719-9104
Mailing address
539 Locust Point Rd
Rumson, NJ 07760-2321
Phone (732) 204-2780
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in NJ
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: No
Enrollment records 1
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Physician Assistant
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 011176 | NY | MD | Physician Assistant |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Meridian Medical Group - Specialty Care, PC | Past | Accepting new patients | |
| Meridian Medical Group-Retail Clinic PC | Past | Accepting new patients |
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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
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NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1170028800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1276560000000",
"number": "1588700405",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "539 LOCUST POINT RD",
"city": "RUMSON",
"state": "NJ",
"postal_code": "077602321",
"telephone_number": "732-204-2780"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2101 ROUTE 34 STE D",
"city": "WALL TOWNSHIP",
"state": "NJ",
"postal_code": "077199104",
"telephone_number": "732-974-0003"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PORTER",
"first_name": "HEATHER",
"middle_name": "M",
"name_prefix": "Ms.",
"credential": "PA-C",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2007-01-29",
"last_updated": "2010-06-15",
"status": "A"
},
"taxonomies": [
{
"code": "363A00000X",
"taxonomy_group": "",
"desc": "Physician Assistant",
"state": "NY",
"license": "011176",
"primary": false
},
{
"code": "363A00000X",
"taxonomy_group": "",
"desc": "Physician Assistant",
"state": "NJ",
"license": "25MP00202900",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Wall Township, NJ
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 15, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.