Clifford Daniel Heaberlin

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

D10706 Issued in OR

Practice address

9775 SE Sunnyside Rd Ste 200
Clackamas, OR 97015-5721

Phone

(503) 655-8471

NPI assigned

May 18, 2017

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in OR

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Interoperability endpoints

• Direct secure messaging: cheaberlin214435@direct.ochin.org

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

{
    "created_epoch": "1495065600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1501113600000",
    "number": "1700313871",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4211 N MISSISSIPPI AVE",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972173132"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9775 SE SUNNYSIDE RD STE 200",
            "city": "CLACKAMAS",
            "state": "OR",
            "postal_code": "970155721",
            "telephone_number": "503-655-8471"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HEABERLIN",
        "first_name": "CLIFFORD",
        "middle_name": "DANIEL",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2017-05-18",
        "last_updated": "2017-07-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "OR",
            "license": "D10706",
            "primary": true
        },
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Michael Jeffrey Hayes, M.D.
• Aaliyah Haynes
• Gary Haynes, RRT
• Jennifer Haynes
• Mackenzie Hays, LMT
• Julia Grace Head, M.D.
• Healing Horizon Residential Treatment Facility LLC
• Healthy Living Chiropractic and Wellness Center
• Healthyu Nutrition
• Thatcher Healy

• General Practice Dentistry in Clackamas, OR
• Providers in Clackamas, OR by specialty
• General Practice Dentistry in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 27, 2017; 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.