Active NPI
Elise Heidorn, MD
- Surgery Physician
- West Reading, PA
National Provider Identifier
1700403888
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Surgery Physician
- License
- MT219787
- Practice address
- 420 S 5TH Ave
West Reading, PA 19611-2143 - Phone
- (484) 628-4908
- NPI assigned
- Jul 6, 2020
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Surgery Physician | 208600000X | MT219787 | PA | Primary |
Addresses
Primary practice location
420 S 5TH Ave
West Reading, PA 19611-2143
Mailing address
PO Box 13579
Reading, PA 19612-3579
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in PA
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: Yes
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20210722001675 | PA | Order and Referring Only - General Surgery | 2668875048 |
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": "1593993600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1593993600000",
"number": "1700403888",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 13579",
"city": "READING",
"state": "PA",
"postal_code": "196123579"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "420 S 5TH AVE",
"city": "WEST READING",
"state": "PA",
"postal_code": "196112143",
"telephone_number": "484-628-4908"
}
],
"practiceLocations": [],
"basic": {
"last_name": "HEIDORN",
"first_name": "ELISE",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2020-07-06",
"last_updated": "2020-07-06",
"certification_date": "2020-07-06",
"status": "A"
},
"taxonomies": [
{
"code": "208600000X",
"taxonomy_group": "",
"desc": "Surgery",
"state": "PA",
"license": "MT219787",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in West Reading, PA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 6, 2020; 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.