Individual provider Active NPI

Heather Bennett Schickedanz, M.D.

  • Family Medicine Physician
  • Santa Monica, CA
National Provider Identifier
1679875223
Registry record updated Feb 25, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
A115878 Issued in CA
Practice address
1250 16TH St Ste A454
Sfvamc BLDG 1, 300. Mail 181G.
Santa Monica, CA 90404-1249
Phone
(310) 319-4698
NPI assigned
Dec 1, 2010
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 25, 2015

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

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X A115878 CA Primary
Hospitalist Physician 208M00000X A115878 CA
Geriatric Medicine (Internal Medicine) Physician 207RG0300X A115878 CA
Student in an Organized Health Care Education/Training Program 390200000X

Addresses

Primary practice location

1250 16TH St Ste A454
Sfvamc BLDG 1, 300. Mail 181G.
Santa Monica, CA 90404-1249

Mailing address

5767 W Century Blvd
Suite 400
Los Angeles, CA 90045-5631
Phone (310) 319-4698

Other names 1

  • Heather Dawn Bennett Former name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA
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

Enrollment IDStateProvider typePAC IDDetails
I20141121000448 CA Practitioner - Family PracticePractitioner - Geriatric Medicine 9335361690 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family PracticeAlso: Geriatric Medicine
Education
University of California, San Francisco School of Medicine, 2010
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
County of Los AngelesGroup PAC ID 1850296534, 395 clinicians

Practice addresses (Care Compare)

12021 S Wilmington Ave
Room 1059
Los Angeles, CA 90059-3019

14445 Olive View Dr
Sylmar, CA 91342-1437
Phone (818) 364-3001

Hospital & facility affiliations

  • Healthy Palace Home Health Care, Inc Home health agency, Glendale, CA, CCN 757460
  • Lac/Harbor-UCLA Med Center Hospital, Torrance, CA, CCN 050376

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
120407CAMDMarriage & Family Therapist
A115878CAMDInternal Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
County of Los Angeles CurrentSince May 1, 2015 Accepting new patients
County of Los Angeles Auditor Controller CurrentSince May 1, 2015 Accepting new patients
County of Los Angeles Current Accepting new patients
Regents Univ of Calif Los Angeles Past Accepting new patients

Locations

14445 Olive View Dr
Sylmar, CA 91342
Phone (881) 836-4303

Organizations & group practices 4

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 2

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": "1291161600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1424822400000",
    "number": "1679875223",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5767 W CENTURY BLVD",
            "address_2": "SUITE 400",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900455631",
            "telephone_number": "310-319-4698"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1250 16TH ST STE A454",
            "address_2": "SFVAMC BLDG 1, 300. MAIL 181G.",
            "city": "SANTA MONICA",
            "state": "CA",
            "postal_code": "904041249",
            "telephone_number": "310-319-4698"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SCHICKEDANZ",
        "first_name": "HEATHER",
        "middle_name": "BENNETT",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2010-12-01",
        "last_updated": "2015-02-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "CA",
            "license": "A115878",
            "primary": true
        },
        {
            "code": "208M00000X",
            "taxonomy_group": "",
            "desc": "Hospitalist",
            "state": "CA",
            "license": "A115878",
            "primary": false
        },
        {
            "code": "207RG0300X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Geriatric Medicine",
            "state": "CA",
            "license": "A115878",
            "primary": false
        },
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "HEATHER",
            "last_name": "BENNETT",
            "middle_name": "DAWN",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Santa Monica, CA

Sources for this page

Verify at the official NPI Registry.