NPIMap

Individual provider Active NPI

Shelly M Heidelbaugh, MD

  • Internal Medicine Physician
  • Dallas, TX
National Provider Identifier
1972545747
Registry record updated Dec 12, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
Q8260 Issued in TX
Practice address
1801 Inwood Rd
Dallas, TX 75390
Phone
(214) 645-7995
NPI assigned
Jun 13, 2006
Last updated
Dec 12, 2018By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 12, 2018

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X A66962 CA
Internal Medicine Physician 207R00000X Q8260 TX Primary

Addresses

Primary practice location

1801 Inwood Rd
Dallas, TX 75390

Mailing address

PO Box 845347
Dallas, TX 75284-7208

Other practice location 1

6300 W Parker Rd
Medical Office Building 2, Suite 220
Plano, TX 75093-8100
Phone (972) 981-8215

Other identifiers 1

IdentifierTypeStateIssuer
00A669620MedicaidCA

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TX
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20181022000305 TX Practitioner - Internal Medicine 3577525195 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Internal Medicine
Education
Ohio State University College of Medicine, 1994
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices

Practice addresses (Care Compare)

12950 Dallas Pkwy
Suite 500
Frisco, TX 75033-4236
Phone (469) 495-2540

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
66962CAMDPharmacist
A66962CAMDInternal Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
The University of Texas Southwestern Medical Center at Dallas CurrentSince Nov 1, 2018 Accepting new patients
University of Texas Southwestern Medical Center at Dallas Internal Medicine CurrentSince Nov 1, 2018 Accepting new patients
University of Texas Southwestern Medical Center at Dallas Current Accepting new patients

Locations

1801 Inwood Rd
Dallas, TX 75235
Phone (214) 645-2035

2201 Inwood Rd
Dallas, TX 75235
Phone (214) 645-2563

3000 N Interstate 35
Denton, TX 76201
Phone (469) 303-3591

12950 Dallas Pkwy
Ste 500
Frisco, TX 75033
Phone (469) 495-2540

3621 22nd St
Ste 400
Lubbock, TX 79410
Phone (806) 791-8484

6300 W Parker Rd
Ste 220
Plano, TX 75093
Phone (972) 981-8215

5323 Harry Hines Blvd
Ut Southwest Medical Center, TX 75390

Interoperability endpoints

  • Direct secure messaging: sheidelbaugh130402@direct.swmed.us

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 6

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1150156800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1544572800000",
    "number": "1972545747",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 845347",
            "city": "DALLAS",
            "state": "TX",
            "postal_code": "752847208"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1801 INWOOD RD",
            "city": "DALLAS",
            "state": "TX",
            "postal_code": "75390",
            "telephone_number": "214-645-7995"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "6300 W Parker Rd",
            "address_2": "Medical Office Building 2, Suite 220",
            "address_purpose": "LOCATION",
            "city": "Plano",
            "state": "TX",
            "postal_code": "750938100",
            "country_code": "US",
            "telephone_number": "972-981-8215",
            "fax_number": "972-981-8399",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "HEIDELBAUGH",
        "first_name": "SHELLY",
        "middle_name": "M",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-06-13",
        "last_updated": "2018-12-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "CA",
            "license": "A66962",
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "TX",
            "license": "Q8260",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00A669620",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Dallas, TX

Sources for this page

Verify at the official NPI Registry.