Kevin Floyd Heacock, M.D.

Primary specialty

Psychiatry PhysicianTaxonomy code 2084P0800X

License

25951 Issued in NE

Practice address

2510 Fifth St., BLDG 840
RM W106D
Wright-Patterson AFB, OH 45433-7913

Phone

(937) 938-2702

NPI assigned

Nov 14, 2006

Last updated

Apr 26, 2018By the provider in NPPES

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Eligible to order & refer

• Part B services: No
• Medical equipment: Yes
• Home health: No
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

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.

• Brightside Medical, P.C.

  • Psychiatry Physician
  • San Francisco, CA
  • NPI 1801355482
  NPD (past)

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

{
    "created_epoch": "1163462400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1524700800000",
    "number": "1871665257",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2510 FIFTH ST., BLDG 840",
            "address_2": "RM W106D",
            "city": "WRIGHT-PATTERSON AFB",
            "state": "OH",
            "postal_code": "454337913",
            "telephone_number": "937-938-2702"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2510 FIFTH ST., BLDG 840",
            "address_2": "RM W106D",
            "city": "WRIGHT-PATTERSON AFB",
            "state": "OH",
            "postal_code": "454337913",
            "telephone_number": "937-938-2702"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2510 Fifth St., Bldg 840",
            "address_2": "Rm W106D",
            "address_purpose": "LOCATION",
            "city": "Wright-Patterson AFB",
            "state": "OH",
            "postal_code": "454337913",
            "country_code": "US",
            "telephone_number": "937-938-2702",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "HEACOCK",
        "first_name": "KEVIN",
        "middle_name": "FLOYD",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-11-14",
        "last_updated": "2018-04-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "MD",
            "license": "D65268",
            "primary": false
        },
        {
            "code": "2084P0800X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "NE",
            "license": "25951",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• John Michael Hatfield, DO, DC, MPH, MOH
• Barabara Ann Hawk, RPT
• Jeremy Allen Haysley, M.D.
• Gretchen Lyn Haywood, AUD
• Gordon Anthony Hazlette, CRNA
• Amber Rose Heller
• Alison Hanna Helmkamp, DO
• Christopher George Herman
• Bryan Hersch, FNP
• Roger Ronald Hesselbrock, M.D.

• Psychiatry Physician in Wright Patterson AFB, OH
• Providers in Wright Patterson AFB, OH by specialty
• Psychiatry Physician in Ohio

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 26, 2018; 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.

Verify at the official NPI Registry.