NPIMap

Individual provider Active NPI

John Casey Heffernan, DO

  • Internal Medicine Physician
  • Walla Walla, WA
National Provider Identifier
1750818019
Registry record updated Sep 5, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
OP61434635 Issued in WA
Practice address
380 Chase Ave
Walla Walla, WA 99362-2924
Phone
(509) 897-5836
Fax
(509) 897-5743
NPI assigned
May 17, 2017
Last updated
Sep 5, 2024By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 5, 2024

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X OP61434635 WA Primary

Addresses

Primary practice location

380 Chase Ave
Walla Walla, WA 99362-2924

Mailing address

380 Chase Ave
Walla Walla, WA 99362-2924
Phone (509) 897-5836

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NJ, WA2 enrollments
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20200608000688 NJ Practitioner - Internal Medicine 8426479098 Reassigns benefits to 1 organization
I20240205001735 WA Practitioner - Internal Medicine 8426479098 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Internal Medicine
Education
Other, 2017
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices

Practice addresses (Care Compare)

380 Chase Ave
Walla Walla, WA 99362-2924
Phone (509) 897-3333

Hospital & facility affiliations

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Providence Health & Services - Washington CurrentSince Jan 15, 2024 Accepting new patients
Providence Health & Services - Washington Internal Medicine CurrentSince Jan 15, 2024 Accepting new patients
Medical Associates of Englewood, PC Internal Medicine CurrentSince Jul 1, 2020 Accepting new patients
Providence Health & Services - Washington Past Accepting new patients

Locations

177 N Dean St
Ph 1
Englewood, NJ 07631
Phone (201) 567-1140

24 Elm St
Ste 203
Harrington Pk, NJ 07640
Phone (201) 784-0123

7600 River Rd
North Bergen, NJ 07047
Phone (201) 854-5000

433 57th St
Ste 720
West New York, NJ 07093

435 57th St
West New York, NJ 07093
Phone (201) 295-1456

380 Chase Ave
Walla Walla, WA 99362
Phone (509) 526-3333

401 W Poplar St
Walla Walla, WA 99362
Phone (509) 522-5731

Interoperability endpoints

  • Direct secure messaging: jheffernan285171@direct.englewoodhealth.org
  • Direct secure messaging: jheffernan3115005@wm.providencedirect.org

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 9

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": "1494979200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1725494400000",
    "number": "1750818019",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "380 CHASE AVE",
            "city": "WALLA WALLA",
            "state": "WA",
            "postal_code": "993622924",
            "telephone_number": "509-897-5836",
            "fax_number": "509-897-5743"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "380 CHASE AVE",
            "city": "WALLA WALLA",
            "state": "WA",
            "postal_code": "993622924",
            "telephone_number": "509-897-5836",
            "fax_number": "509-897-5743"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HEFFERNAN",
        "first_name": "JOHN",
        "middle_name": "CASEY",
        "credential": "DO",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2017-05-17",
        "last_updated": "2024-09-05",
        "certification_date": "2024-09-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "WA",
            "license": "OP61434635",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Walla Walla, WA

Sources for this page

Verify at the official NPI Registry.