Kristyn Emily Heagerty, PA
Individual provider Active NPI Physician Assistant · Madison, OH
NPI 1972057396 · NPPES record last updated Jun 6, 2022
Key facts
- NPI
- 1972057396
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Physician Assistant 363A00000X
- License
- 50.004808RX (OH)
- Practice address
- 2999 McMackin Rd
Madison, OH 44057-2330 - Phone
- (440) 428-1111
- NPI assigned
- Aug 15, 2016
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 18
Hospital & facility affiliations 1
Medicare Care Compare profile
- Specialty
- Physician Assistant
- Education
- Other, 2016
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- Cleveland Clinic
Practice addresses (Care Compare)
2570 Som Ctr Rd
Willoughby Hills, OH 44094-9607
Phone (440) 943-2500
2999 McMackin Rd
Madison, OH 44057-2330
Phone (440) 428-1111
8950 Euclid Ave
Cleveland, OH 44195-0001
Phone (216) 444-8950
9500 Euclid Ave
Cleveland, OH 44195-0001
Hospital & facility affiliations
- Cleveland Clinic
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in OH
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: No
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20161117001713 | OH | Practitioner - Physician Assistant | 1850670688 | Reassigns benefits to 4 organizations |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Physician Assistant
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 50.004808RX | OH | MD | Physician Assistant |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Wooster Clinic, LLC | Current |
Accepting new patients | |
| The Cleveland Clinic Foundation | Current |
Accepting new patients | |
| Ashtabula County Medical Center | Current |
Accepting new patients | |
| Euclid Hospital Cleveland Clinic Health System | Current | Accepting new patients |
Locations
2420 Lake Ave
Ashtabula, OH 44004
Phone (216) 986-2919
9500 Euclid Ave
Cleveland, OH 44195
Phone (216) 442-1270
2999 McMackin Rd
Madison, OH 44057
Phone (440) 428-1111
18697 Bagley Rd
Middleburg Heights, OH 44130
Phone (440) 816-8000
6801 Brecksville Rd
Ste 20
Seven Hills, OH 44131
Phone (216) 445-3363
1740 Cleveland Rd
Wooster, OH 44691
Phone (330) 287-4500
Interoperability endpoints
- kpristov398416@direct.ccf.org
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | 50.004808RX | OH | |
| Student in an Organized Health Care Education/Training Program | 390200000X | |||
| Physician Assistant | 363A00000X | 50.004808RX | OH | Yes |
Addresses
Primary practice location
2999 McMackin Rd
Madison, OH 44057-2330
Mailing address
307 S Evergreen Ave
Woodbury, NJ 08096-2739
Phone (856) 686-4306
Other providers in Madison, OH
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jun 6, 2022. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.