Individual provider Active NPI

Heather S Gangloff, PA

  • Medical Physician Assistant
  • Concord, MA
National Provider Identifier
1649234899
Registry record updated Nov 16, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Medical Physician AssistantTaxonomy code 363AM0700X
License
1273 Issued in MA
Practice address
330 Baker Ave
Concord, MA 01742-2129
Phone
(978) 287-9300
NPI assigned
Apr 14, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 16, 2020

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X 1273 MA
Medical Physician Assistant 363AM0700X 1273 MA Primary

Addresses

Primary practice location

330 Baker Ave
Concord, MA 01742-2129

Mailing address

330 Baker Ave
Concord, MA 01742-2129
Phone (978) 287-9300

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address hgangloff12289@direct.atrius.masshiway.net

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MA
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
I20081126000023 MA Practitioner - Physician Assistant 8729148408

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

State licenses

LicenseStateTypeSpecialty
1273MAMDMedical Physician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Atrius Health, Inc. Physician Assistant CurrentSince Jun 4, 2001 Accepting new patients
Atrius Health, Inc. Physician Assistant Past Accepting new patients

Locations

147 Milk St
Fl 9
Boston, MA 02109
Phone (617) 559-8051

133 Brookline Ave
Boston, MA 02215
Phone (617) 421-1000

147 Milk St
#9
Boston, MA 02109
Phone (617) 859-5170

330 Baker Ave
Concord, MA 01742
Phone (978) 287-9300

Interoperability endpoints

  • Direct secure messaging: hgangloff12289@direct.atrius.masshiway.net

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.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1144972800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1605484800000",
    "number": "1649234899",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "330 BAKER AVE",
            "city": "CONCORD",
            "state": "MA",
            "postal_code": "017422129",
            "telephone_number": "978-287-9300"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "330 BAKER AVE",
            "city": "CONCORD",
            "state": "MA",
            "postal_code": "017422129",
            "telephone_number": "978-287-9300"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GANGLOFF",
        "first_name": "HEATHER",
        "middle_name": "S",
        "credential": "PA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-04-14",
        "last_updated": "2020-11-16",
        "certification_date": "2020-11-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "MA",
            "license": "1273",
            "primary": false
        },
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "MA",
            "license": "1273",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "hgangloff12289@direct.atrius.masshiway.net",
            "affiliation": "N",
            "address_1": "330 Baker Ave",
            "city": "Concord",
            "state": "MA",
            "country_code": "US",
            "postal_code": "017422129",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Concord, MA

Sources for this page

Verify at the official NPI Registry.