Active NPI
Mary Rebecca Heaton, PAC
- Medical Physician Assistant
- Jamaica Plain, MA
National Provider Identifier
1902956931
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Medical Physician Assistant
- License
- 334
- Practice address
- 170 Morton St
Lemuel Shattuck Hospital
Jamaica Plain, MA 02130-3735 - Phone
- (617) 522-8110
- NPI assigned
- Jan 11, 2007
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Medical Physician Assistant | 363AM0700X | 334 | MA | Primary |
Addresses
Primary practice location
170 Morton St
Lemuel Shattuck Hospital
Jamaica Plain, MA 02130-3735
Mailing address
170 Morton St
Jamaica Plain, MA 02130-3735
Phone (617) 971-3282
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in MA
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: No
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20160304001600 | MA | Order and Referring Only - Physician Assistant | 0446339022 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Physician Assistant
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 334 | MA | MD | Behavioral Analyst |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1168473600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1452124800000",
"number": "1902956931",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "170 MORTON ST",
"city": "JAMAICA PLAIN",
"state": "MA",
"postal_code": "021303735",
"telephone_number": "617-971-3282"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "170 MORTON ST",
"address_2": "LEMUEL SHATTUCK HOSPITAL",
"city": "JAMAICA PLAIN",
"state": "MA",
"postal_code": "021303735",
"telephone_number": "617-522-8110"
}
],
"practiceLocations": [],
"basic": {
"last_name": "HEATON",
"first_name": "MARY",
"middle_name": "REBECCA",
"credential": "PAC",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2007-01-11",
"last_updated": "2016-01-07",
"status": "A"
},
"taxonomies": [
{
"code": "363AM0700X",
"taxonomy_group": "",
"desc": "Physician Assistant, Medical",
"state": "MA",
"license": "334",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Jamaica Plain, MA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 7, 2016; 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.