Individual provider Active NPI

Anne Elizabeth Heenan, MD

  • Internal Medicine Physician
  • Parker, CO
National Provider Identifier
1750801809
Registry record updated Sep 1, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
DR.0067108 Issued in CO
Practice address
10168 Parkglenn Way
Parker, CO 80138-3868
Phone
(303) 338-4545
NPI assigned
Jun 20, 2017
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 1, 2021

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X 7954 NE
Pediatrics Physician 208000000X 7954 NE
Internal Medicine Physician 207R00000X DR.0067108 CO Primary

Addresses

Primary practice location

10168 Parkglenn Way
Parker, CO 80138-3868

Mailing address

10350 E Dakota Ave
Denver, CO 80247-1314

Other identifiers 1

IdentifierTypeStateIssuer
029221OtherCOKAISER COMMERCIAL NUMBER

Other names 1

  • Anne Elizabeth Archer Former name

Electronic endpoints 1

TypeEndpointUseAffiliation
SOAP URL https://careepiceast.kp.org:14430/Interconnect-prodcom/wcf/epic.community.hie/xcpdrespondinggatewaysync.svc/ceq Health Information Exchange (HIE)

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CO
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
I20210910000826 CO Practitioner - Internal Medicine 3870866940 Reassigns benefits to 1 organization

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
7954NEMDDentist

Practice roles

OrganizationSpecialtyStatusNew patients
Colorado Permanente Medical Group, P.C. Internal Medicine CurrentSince Sep 13, 2021 Accepting new patients

Locations

10350 E Dakota Ave
Denver, CO 80247
Phone (303) 636-3350

12249 Pine Bluffs Way
Parker, CO 80134

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.

NPI Registry JSON

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

{
    "created_epoch": "1497916800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1630454400000",
    "number": "1750801809",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10350 E DAKOTA AVE",
            "city": "DENVER",
            "state": "CO",
            "postal_code": "802471314"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10168 PARKGLENN WAY",
            "city": "PARKER",
            "state": "CO",
            "postal_code": "801383868",
            "telephone_number": "303-338-4545"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HEENAN",
        "first_name": "ANNE",
        "middle_name": "ELIZABETH",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2017-06-20",
        "last_updated": "2021-09-01",
        "certification_date": "2021-09-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "NE",
            "license": "7954",
            "primary": false
        },
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "NE",
            "license": "7954",
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "CO",
            "license": "DR.0067108",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "KAISER COMMERCIAL NUMBER",
            "identifier": "029221",
            "state": "CO"
        }
    ],
    "endpoints": [
        {
            "endpointType": "SOAP",
            "endpointTypeDescription": "SOAP URL",
            "endpoint": "https://careepiceast.kp.org:14430/Interconnect-prodcom/wcf/epic.community.hie/xcpdrespondinggatewaysync.svc/ceq",
            "affiliation": "N",
            "endpointDescription": "Carequality",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "C-CDA",
            "address_1": "10168 Parkglenn Way",
            "city": "Parker",
            "state": "CO",
            "country_code": "US",
            "postal_code": "801383868",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "first_name": "ANNE",
            "last_name": "ARCHER",
            "middle_name": "ELIZABETH",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Parker, CO

Sources for this page

Verify at the official NPI Registry.