Individual provider Active NPI

Andrew Charles Heideman, PT

  • Physical Therapist
  • Jacksonville, FL
National Provider Identifier
1952306367
Registry record updated Feb 4, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
License
PT21973 Issued in FL
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

Updated by the provider on Feb 4, 2015

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
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

IdentifierTypeStateIssuer
P00295808OtherFLRR MEDICARE

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in FL

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20050427001358 FL Practitioner - Physical Therapist in Private Practice 3971542036 Reassigns benefits to 1 organization

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
Jacksonville Orthopaedic Institute IncGroup PAC ID 5193625499, 60 clinicians

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 100Reported as group
Improvement activities
40
Cost
74.03

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
PT21973FLMDPhysical Therapist

Practice roles

OrganizationSpecialtyStatusNew patients
Jacksonville Orthopaedic Institute Inc Physical Therapist CurrentSince Mar 28, 2005 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.

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.

Verify at the official NPI Registry.