Individual provider Active NPI

Jennifer Renee Heller, D.C.

  • Chiropractor
  • Brunswick, GA
National Provider Identifier
1962732669
Registry record updated May 17, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
ChiropractorTaxonomy code 111N00000X
License
CHIR009588 Issued in GA
Practice address
208 Scranton Connector Ste 120
Brunswick, GA 31525-0561
Phone
(912) 264-2244
Fax
(404) 855-4381
NPI assigned
Jan 4, 2010
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 17, 2021

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Chiropractor 111N00000X 2009039698 MO
Chiropractor 111N00000X CHIR009588 GA Primary

Addresses

Primary practice location

208 Scranton Connector Ste 120
Brunswick, GA 31525-0561

Mailing address

208 Scranton Connector Ste 120
Brunswick, GA 31525-0561
Phone (912) 264-2244

Other identifiers 2

IdentifierTypeStateIssuer
EA2937OtherMEDICARE RRB
P02546258OtherMEDICARE RRB

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20160218000316 GA Practitioner - Chiropractic 9133251507 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Chiropractic
Education
Logan College of Chiropractic, 2009
Medicare assignment
Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

208 Scranton Connector
Suite 120
Brunswick, GA 31525-0561
Phone (912) 264-2244

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
CHIR009588GAMDChiropractor
2009039698MOMDChiropractor

Practice roles

OrganizationSpecialtyStatusNew patients
Brunswick Urgent Care, LLC CurrentSince Apr 1, 2019 Accepting new patients
Heller Family Medicine, LLC PastSince Jun 1, 2016 Accepting new patients

Locations

208 Scranton Connector
Ste 120
Brunswick, GA 31525
Phone (912) 264-2244

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": "1262563200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1621209600000",
    "number": "1962732669",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "208 SCRANTON CONNECTOR STE 120",
            "city": "BRUNSWICK",
            "state": "GA",
            "postal_code": "315250561",
            "telephone_number": "912-264-2244",
            "fax_number": "404-855-4381"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "208 SCRANTON CONNECTOR STE 120",
            "city": "BRUNSWICK",
            "state": "GA",
            "postal_code": "315250561",
            "telephone_number": "912-264-2244",
            "fax_number": "404-855-4381"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HELLER",
        "first_name": "JENNIFER",
        "middle_name": "RENEE",
        "name_prefix": "Dr.",
        "credential": "D.C.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2010-01-04",
        "last_updated": "2021-05-17",
        "certification_date": "2021-05-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "",
            "desc": "Chiropractor",
            "state": "MO",
            "license": "2009039698",
            "primary": false
        },
        {
            "code": "111N00000X",
            "taxonomy_group": "",
            "desc": "Chiropractor",
            "state": "GA",
            "license": "CHIR009588",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE RRB",
            "identifier": "EA2937",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE RRB",
            "identifier": "P02546258",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Brunswick, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 17, 2021; 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.