Individual provider Active NPI

Heather Caudill Puckett, ANP-C

  • Adult Health Nurse Practitioner
  • Concord, NC
National Provider Identifier
1679598791
Registry record updated Nov 11, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Adult Health Nurse PractitionerTaxonomy code 363LA2200X
License
900455 Issued in NC
Practice address
200 Medical Park Dr Ste 400
Concord, NC 28025-0906
Phone
(704) 786-1108
Fax
(704) 782-1826
NPI assigned
Jul 12, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 11, 2021

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Adult Health Nurse Practitioner 363LA2200X 900455 NC Primary

Addresses

Primary practice location

200 Medical Park Dr Ste 400
Concord, NC 28025-0906

Mailing address

200 Medical Park Dr Ste 400
Concord, NC 28025-0906
Phone (704) 786-1108

Other identifiers 1

IdentifierTypeStateIssuer
900455OtherNCNC MEDICAL BOARD LICENSE

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NC
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
I20070605000537 NC Practitioner - Nurse Practitioner 0840398442 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2004
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Paragon Surgical Specialists PAGroup PAC ID 4688636657, 17 clinicians

Practice addresses (Care Compare)

200 Medical Park Dr
Suite 400
Concord, NC 28025-0906
Phone (704) 786-1108

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
94 of 100Reported as apm
Quality
81.63
Promoting interoperability
100
Improvement activities
40

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

Practice roles

OrganizationSpecialtyStatusNew patients
Paragon Surgical Specialists, PA CurrentSince Apr 2, 2007 Accepting new patients

Locations

200 Medical Park Dr
Ste 400
Concord, NC 28025
Phone (704) 786-1108

Interoperability endpoints

  • Direct secure messaging: hpuckett499482@carolinashealthcaresystem.direct-ci.com

Organizations & group practices 1

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 8

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": "1636588800000",
    "number": "1679598791",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "200 MEDICAL PARK DR STE 400",
            "city": "CONCORD",
            "state": "NC",
            "postal_code": "280250906",
            "telephone_number": "704-786-1108",
            "fax_number": "704-782-1826"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "200 MEDICAL PARK DR STE 400",
            "city": "CONCORD",
            "state": "NC",
            "postal_code": "280250906",
            "telephone_number": "704-786-1108",
            "fax_number": "704-782-1826"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PUCKETT",
        "first_name": "HEATHER",
        "middle_name": "CAUDILL",
        "name_prefix": "Mrs.",
        "credential": "ANP-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-07-12",
        "last_updated": "2021-11-11",
        "certification_date": "2021-11-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LA2200X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Adult Health",
            "state": "NC",
            "license": "900455",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NC MEDICAL BOARD LICENSE",
            "identifier": "900455",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Concord, NC

Sources for this page

Verify at the official NPI Registry.