NPIMap

Individual provider Active NPI

David N Heverly, MD

  • Neurology Physician
  • Green Bay, WI
National Provider Identifier
1649205170
Registry record updated Mar 20, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Neurology PhysicianTaxonomy code 2084N0400X
License
42235 Issued in WI
Practice address
725 S Webster Ave
Suite 201
Green Bay, WI 54301-3500
Phone
(920) 430-7100
Fax
(920) 430-7114
NPI assigned
Jul 12, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 20, 2015

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Neurology Physician 2084N0400X 42235 WI Primary

Addresses

Primary practice location

725 S Webster Ave
Suite 201
Green Bay, WI 54301-3500

Mailing address

PO Box 22487
Green Bay, WI 54305-2487
Phone (920) 445-7210

Other identifiers 3

IdentifierTypeStateIssuer
32837700MedicaidWI
33320100MedicaidWI
364608478002OtherWIBLUE CROSS BLUE SHIELD

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MN, MI2 enrollments
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20170213001266 MN Practitioner - Neurology 5496792152 Reassigns benefits to 1 organization
I20210802002049 MI Practitioner - Neurology 5496792152 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Neurology
Education
University of Tennessee, HSC, College of Medicine, 1996
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Centracare ClinicGroup PAC ID 2466363395, 800 clinicians

Practice addresses (Care Compare)

1900 Centracare Cir
Saint Cloud, MN 56303-5000
Phone (320) 654-3630

Hospital & facility affiliations

  • Centracare - St. Cloud Hospital Hospital, Saint Cloud, MN, CCN 240036
  • Alomere Health Hospital, Alexandria, MN, CCN 240030

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
42235WIMDNeurology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Centracare Clinic CurrentSince Jan 10, 2017 Accepting new patients
Covenant Medical Center, Inc. Current Accepting new patients
Centracare Clinic CurrentSince Jan 10, 2017 Accepting new patients
Centracare Clinic Current Accepting new patients
Covenant Medical Center, Inc Neurology CurrentSince Jul 30, 2021 Accepting new patients

Locations

800 Cooper Ave
Ste 11
Saginaw, MI 48602
Phone (989) 583-7090

1447 N Harrison St
Saginaw, MI 48602
Phone (989) 583-4220

1200 6th Ave N
Saint Cloud, MN 56303
Phone (320) 252-3342

1900 Centracare Cir
Saint Cloud, MN 56303
Phone (320) 252-2422

Interoperability endpoints

  • Direct secure messaging: dheverly333339@direct.centracare.com

Organizations & group practices 5

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": "1152662400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1426809600000",
    "number": "1649205170",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 22487",
            "city": "GREEN BAY",
            "state": "WI",
            "postal_code": "543052487",
            "telephone_number": "920-445-7210",
            "fax_number": "920-445-7289"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "725 S WEBSTER AVE",
            "address_2": "SUITE 201",
            "city": "GREEN BAY",
            "state": "WI",
            "postal_code": "543013500",
            "telephone_number": "920-430-7100",
            "fax_number": "920-430-7114"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HEVERLY",
        "first_name": "DAVID",
        "middle_name": "N",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-07-12",
        "last_updated": "2015-03-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2084N0400X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Neurology",
            "state": "WI",
            "license": "42235",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "32837700",
            "state": "WI"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "33320100",
            "state": "WI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD",
            "identifier": "364608478002",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Green Bay, WI

Sources for this page

Verify at the official NPI Registry.