Active NPI
Andrew Charles Heideman, PT
- Physical Therapist
- Jacksonville, FL
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- PT21973
- Practice address
- 1325 San Marco Blvd Ste 102
Credentialing Department
Jacksonville, FL 32207-8549 - Phone
- (904) 858-7045
- Fax
- (904) 858-7047
- NPI assigned
- Jun 14, 2005
- Sex
- Male
- 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 |
|---|---|---|---|---|
| Physical Therapist | 225100000X | PT21973 | FL | Primary |
Addresses
Primary practice location
1325 San Marco Blvd Ste 102
Credentialing Department
Jacksonville, FL 32207-8549
Mailing address
PO Box 40767
Credentialing Department
Jacksonville, FL 32203-0767
Phone (904) 376-3707
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| P00295808 | Other | FL | RR MEDICARE |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in FL
Enrollment records 1
Care Compare profile
Medicare Care Compare- Specialty
- Physical Therapist in Private Practice
- Education
- Other, 2004
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
Practice addresses (Care Compare)
1325 San Marco Blvd
Suite 102
Jacksonville, FL 32207-8549
Phone (904) 858-7045
Merit-based Incentive Payment System (MIPS)
- Final score
- 87.01 of 100
- Improvement activities
- 40
- Cost
- 74.03
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PT21973 | FL | MD | Physical Therapist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Jacksonville Orthopaedic Institute Inc | Physical Therapist | Current | Accepting new patients |
Locations
1325 San Marco Blvd
Ste 102
Jacksonville, FL 32207
Phone (904) 557-9021
1325 San Marco Blvd
Ste 200
Jacksonville, FL 32207
Phone (904) 346-3465
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.
-
- Orthopaedic Surgery Physician
- Jacksonville, FL
- NPI 1346298023
Physical Therapist
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1118707200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1423008000000",
"number": "1952306367",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 40767",
"address_2": "CREDENTIALING DEPARTMENT",
"city": "JACKSONVILLE",
"state": "FL",
"postal_code": "322030767",
"telephone_number": "904-376-3707",
"fax_number": "904-391-5807"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1325 SAN MARCO BLVD STE 102",
"address_2": "CREDENTIALING DEPARTMENT",
"city": "JACKSONVILLE",
"state": "FL",
"postal_code": "322078549",
"telephone_number": "904-858-7045",
"fax_number": "904-858-7047"
}
],
"practiceLocations": [],
"basic": {
"last_name": "HEIDEMAN",
"first_name": "ANDREW",
"middle_name": "CHARLES",
"credential": "PT",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2005-06-14",
"last_updated": "2015-02-04",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "FL",
"license": "PT21973",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "RR MEDICARE",
"identifier": "P00295808",
"state": "FL"
}
],
"endpoints": [],
"other_names": []
}
Other providers in Jacksonville, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 4, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
- Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.