Individual provider Active NPI

Heather Lynn Misra, MD

  • Pulmonary Disease Physician
  • Indianapolis, IN
National Provider Identifier
1639171671
Registry record updated Jan 12, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pulmonary Disease PhysicianTaxonomy code 207RP1001X
License
01060694A Issued in IN
Practice address
8330 Naab Rd Ste 340
Indianapolis, IN 46260-2279
Phone
(317) 338-5100
NPI assigned
Aug 10, 2005
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 12, 2017

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Pulmonary Disease Physician 207RP1001X 01060694A IN Primary
Critical Care Medicine (Internal Medicine) Physician 207RC0200X 01060694A IN

Addresses

Primary practice location

8330 Naab Rd Ste 340
Indianapolis, IN 46260-2279

Mailing address

10330 N Meridian St # 300
Indianapolis, IN 46290-1024

Other identifiers 1

IdentifierTypeStateIssuer
200514960MedicaidIN

Other names 1

  • Heather Lynn Wallace Former name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IN
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
I20050517000410 IN Practitioner - Pulmonary DiseasePractitioner - Critical Care (Intensivists)Practitioner - Internal Medicine 6002857356 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Pulmonary DiseaseAlso: Critical Care (Intensivists), Internal Medicine
Education
Northeastern Ohio University College of Medicine, 1999
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
St Vincent Medical Group IncGroup PAC ID 7012047640, 728 clinicians

Practice addresses (Care Compare)

2001 W 86TH St
Indianapolis, IN 46260-1902
Phone (317) 338-2345

250 W 96TH St
Suite 520
Indianapolis, IN 46260-1317

8433 Harcourt Rd
Suite 100
Indianapolis, IN 46260-2193
Phone (317) 583-7600

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
01060694AINMDCritical Care Medicine (Internal Medicine) Physician

Practice roles

OrganizationSpecialtyStatusNew patients
St. Vincent Medical Group, Inc. CurrentSince Jun 22, 2014 Accepting new patients
St. Vincent Medical Group, Inc. CurrentSince Jun 22, 2014 Accepting new patients
Respiratory & Critical Care Consultants P C Critical Care Medicine Past Accepting new patients
Major Hospital Past Accepting new patients

Locations

13500 N Meridian St
Carmel, IN 46032
Phone (317) 573-7000

8433 Harcourt Rd
Ste 100
Indianapolis, IN 46260
Phone (317) 583-7702

8333 Naab Rd
Ste 250
Indianapolis, IN 46260
Phone (317) 338-5100

2010 W 86th St
Ste 111
Indianapolis, IN 46260
Phone (317) 415-6580

8330 Naab Rd
Ste 340
Indianapolis, IN 46260
Phone (317) 338-5100

Interoperability endpoints

  • Direct secure messaging: heather.misra.1@7598.direct.athenahealth.com

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 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": "1123632000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1484179200000",
    "number": "1639171671",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10330 N MERIDIAN ST # 300",
            "city": "INDIANAPOLIS",
            "state": "IN",
            "postal_code": "462901024"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8330 NAAB RD STE 340",
            "city": "INDIANAPOLIS",
            "state": "IN",
            "postal_code": "462602279",
            "telephone_number": "317-338-5100"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MISRA",
        "first_name": "HEATHER",
        "middle_name": "LYNN",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2005-08-10",
        "last_updated": "2017-01-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207RP1001X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Pulmonary Disease",
            "state": "IN",
            "license": "01060694A",
            "primary": true
        },
        {
            "code": "207RC0200X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Critical Care Medicine",
            "state": "IN",
            "license": "01060694A",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "200514960",
            "state": "IN"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "HEATHER",
            "last_name": "WALLACE",
            "middle_name": "LYNN",
            "credential": "MD",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Indianapolis, IN

Sources for this page

Verify at the official NPI Registry.