Individual provider Active NPI

David Heisig, MD

  • Gastroenterology Physician
  • Syracuse, NY
National Provider Identifier
1851305437
Registry record updated Nov 20, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Gastroenterology PhysicianTaxonomy code 207RG0100X
License
164528 Issued in NY
Practice address
4870 Broad Rd
Suite 3Q
Syracuse, NY 13215-2206
Phone
(315) 492-5765
Fax
(315) 492-5123
NPI assigned
Jul 28, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 20, 2015

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Gastroenterology Physician 207RG0100X 164528 NY Primary

Addresses

Primary practice location

4870 Broad Rd
Suite 3Q
Syracuse, NY 13215-2206

Mailing address

4870 Broad Rd
Suite 3Q
Syracuse, NY 13215-2206
Phone (315) 492-5765

Other identifiers 1

IdentifierTypeStateIssuer
00978276MedicaidNY

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NY
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
I20101202000359 NY Practitioner - GastroenterologyPractitioner - Internal Medicine 5597951558 Reassigns benefits to 1 organization

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Department of Medicine Medical Serv GRP at Suny HLTH Sci Ctr Syr in Gastroenterology CurrentSince Jul 1, 2014 Accepting new patients
Department of Medicine Medical Service Group CurrentSince Jul 1, 2014 Accepting new patients
Loretto Health and Rehabilitation Center Past Accepting new patients

Locations

251 Salina Meadows Pkwy
Ste 100
Syracuse, NY 13212
Phone (315) 464-2000

750 E Adams St
Syracuse, NY 13210
Phone (315) 464-4363

Interoperability endpoints

  • Direct secure messaging: dheisig@hiemail.healtheconnections.org

Organizations & group practices 3

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": "1154044800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1447977600000",
    "number": "1851305437",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4870 BROAD RD",
            "address_2": "SUITE 3Q",
            "city": "SYRACUSE",
            "state": "NY",
            "postal_code": "132152206",
            "telephone_number": "315-492-5765",
            "fax_number": "315-492-5123"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4870 BROAD RD",
            "address_2": "SUITE 3Q",
            "city": "SYRACUSE",
            "state": "NY",
            "postal_code": "132152206",
            "telephone_number": "315-492-5765",
            "fax_number": "315-492-5123"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HEISIG",
        "first_name": "DAVID",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-07-28",
        "last_updated": "2015-11-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207RG0100X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Gastroenterology",
            "state": "NY",
            "license": "164528",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00978276",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Syracuse, NY

Sources for this page

Verify at the official NPI Registry.