Heidi L Lodge, MD

Primary specialty

Internal Medicine PhysicianTaxonomy code 207R00000X

License

22674 Issued in AZ

Practice address

100 E 5TH St
Ste 350
Douglas, AZ 85607-2859

Phone

(520) 364-7659

Fax

(520) 364-8541

NPI assigned

May 20, 2006

Last updated

Aug 12, 2022By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Heidi Leake Former name

Electronic endpoints 1

Medicare fee-for-service enrollment

Enrolled in AZ

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

Specialty

Internal Medicine

Education

Emory University School of Medicine, 1988

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Bisbee Hospital AssociationGroup PAC ID 5092626168, 69 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Copper Queen Community Hospital Hospital, Bisbee, AZ, CCN 031312

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: heidilodge@cqch.cernerdirect.com

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.

• Bisbee Hospital Association

  • Critical Access Hospital
  • Bisbee, AZ
  • NPI 1518968767
  Medicare reassignment Care Compare group NPD
• Bisbee Hospital Association

  dba Copper Queen Community Hospital Hereford RHC

  • Rural Health Clinic/Center
  • Hereford, AZ
  • NPI 1245986975
  NPD
• Bisbee Hospital Association

  dba Copper Queen Medical Associates Bisbee

  • Clinic/Center
  • Bisbee, AZ
  • NPI 1568471696
  NPD (past)

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

• Bisbee Hospital Association

  • Critical Access Hospital
  • Bisbee, AZ
  • NPI 1518968767
  Care Compare affiliation

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

{
    "created_epoch": "1148083200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1660262400000",
    "number": "1669426144",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "101 COLE AVE",
            "city": "BISBEE",
            "state": "AZ",
            "postal_code": "856031327",
            "telephone_number": "520-432-6481",
            "fax_number": "520-432-5082"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "100 E 5TH ST",
            "address_2": "STE 350",
            "city": "DOUGLAS",
            "state": "AZ",
            "postal_code": "856072859",
            "telephone_number": "520-364-7659",
            "fax_number": "520-364-8541"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LODGE",
        "first_name": "HEIDI",
        "middle_name": "L",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-05-20",
        "last_updated": "2022-08-12",
        "certification_date": "2020-09-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "AZ",
            "license": "22674",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "892887",
            "state": "AZ"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "HEIDILODGE@cqch.cernerdirect.com",
            "affiliation": "N",
            "endpointDescription": "Copper Queen Hospital  Douglas RHC",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "CCDA",
            "address_1": "100 E 5th St",
            "address_2": "Ste 350",
            "city": "Douglas",
            "state": "AZ",
            "country_code": "US",
            "postal_code": "856072859",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "first_name": "HEIDI",
            "last_name": "LEAKE",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Lilia Lara
• Julia Larez, RN
• Mauricio G. Larios, DDS
• Lesan Assisted Living, L.L.C.
• Gabriel Lindstrom, FNP
• Gabrielle Alexandra Lugo, ARNP
• Dia Cherie Madden, FNP
• Aman Paul Mansury, MD
• Eduardo Antonio Marrero Velis
• Alexis Martinez

• Internal Medicine Physician in Douglas, AZ
• Providers in Douglas, AZ by specialty
• Internal Medicine Physician in Arizona

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 12, 2022; 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.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.