Thomas Heidenreich, D.D.S.

Primary specialty

Oral and Maxillofacial Surgery (Dentist)Taxonomy code 1223S0112X

License

S169 Issued in MN

Practice address

3950 Veterans Dr Ste 100
Saint Cloud, MN 56303-3424

Phone

(320) 252-3611

NPI assigned

Aug 12, 2011

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in MN

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

Specialty

Maxillofacial SurgeryAlso: Dentist

Education

Other, 2012

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Centrasota Oral and Maxillofacial Surgeons PAGroup PAC ID 7315969326, 6 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: theidenreich589283@direct.centracare.com

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.

• Centrasota Oral & Maxillofacial Surgeons, P.a.

  • Oral and Maxillofacial Surgery (Dentist)
  • Saint Cloud, MN
  • NPI 1598710477
  Medicare reassignment Care Compare group NPD
• Hennepin Faculty Associates

  • General Practice Physician
  • Minneapolis, MN
  • NPI 1063459485
  NPD (past)

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

{
    "created_epoch": "1313107200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1637712000000",
    "number": "1720367394",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "CENTRASOTA ORAL SURGEONS",
            "address_2": "3950 VETERANS DRIVE, SUITE 100",
            "city": "ST. CLOUD",
            "state": "MN",
            "postal_code": "56303",
            "telephone_number": "320-252-3611",
            "fax_number": "320-252-7574"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3950 VETERANS DR STE 100",
            "city": "SAINT CLOUD",
            "state": "MN",
            "postal_code": "563033424",
            "telephone_number": "320-252-3611"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HEIDENREICH",
        "first_name": "THOMAS",
        "name_prefix": "Dr.",
        "credential": "D.D.S.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2011-08-12",
        "last_updated": "2021-11-24",
        "certification_date": "2021-11-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223S0112X",
            "taxonomy_group": "",
            "desc": "Dentist, Oral and Maxillofacial Surgery",
            "state": "MN",
            "license": "S169",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Kristen J Heffern, ARNP
• April Ann Hegdahl, LICSW
• Katie Lynne Hegdahl, APRN CNP
• Jonathon Heger, D.P.T.
• Susan Heidal-Schiltz, PSYD LP
• Anna Jordan Heiling, DPT
• Matthew Heiling, DPT
• Cassandra Beth Heimer, MD
• Madison Hein, LMFT
• Caren Heinen, RN

• Oral and Maxillofacial Surgery (Dentist) in Saint Cloud, MN
• Providers in Saint Cloud, MN by specialty
• Oral and Maxillofacial Surgery (Dentist) in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 24, 2021; 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.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.