Individual provider Active NPI

John Stephen Heisel, MD

  • Psychiatry Physician
  • Boston, MA
National Provider Identifier
1679511521
Registry record updated Aug 30, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatry PhysicianTaxonomy code 2084P0800X
License
36950 Issued in MA
Practice address
133 Brookline Ave
Boston, MA 02215-3904
Phone
(617) 421-1157
Fax
(617) 421-1063
NPI assigned
Jun 3, 2006
Last updated
Aug 30, 2019By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 30, 2019

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Geriatric Psychiatry Physician 2084P0805X 36950 MA
Psychiatry Physician 2084P0800X 36950 MA Primary

Addresses

Primary practice location

133 Brookline Ave
Boston, MA 02215-3904

Mailing address

1493 Cambridge St
Cambridge, MA 02139-1047
Phone (617) 665-1000

Other identifiers 3

IdentifierTypeStateIssuer
0037411OtherMANEIGHBORHOOD HEALTH PLAN
036950OtherMATUFTS HEALTH PLAN
B07139OtherMABLUE CROSS

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

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

NPI Registry JSON

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

{
    "created_epoch": "1149292800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1567123200000",
    "number": "1679511521",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1493 CAMBRIDGE ST",
            "city": "CAMBRIDGE",
            "state": "MA",
            "postal_code": "021391047",
            "telephone_number": "617-665-1000"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "133 BROOKLINE AVE",
            "city": "BOSTON",
            "state": "MA",
            "postal_code": "022153904",
            "telephone_number": "617-421-1157",
            "fax_number": "617-421-1063"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HEISEL",
        "first_name": "JOHN",
        "middle_name": "STEPHEN",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-06-03",
        "last_updated": "2019-08-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2084P0805X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Geriatric Psychiatry",
            "state": "MA",
            "license": "36950",
            "primary": false
        },
        {
            "code": "2084P0800X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "MA",
            "license": "36950",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NEIGHBORHOOD HEALTH PLAN",
            "identifier": "0037411",
            "state": "MA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "TUFTS HEALTH PLAN",
            "identifier": "036950",
            "state": "MA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS",
            "identifier": "B07139",
            "state": "MA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Boston, MA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 30, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.