Active NPI
Heather Ann Fagan, MD
- Pediatric Critical Care Medicine Physician
- Orlando, FL
National Provider Identifier
1992757504
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pediatric Critical Care Medicine Physician
- License
- ME120308
- Practice address
- 13535 Nemours Pkwy
Orlando, FL 32827-7402 - Phone
- (407) 650-7000
- Fax
- (407) 567-5924
- NPI assigned
- May 16, 2006
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 3
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pediatrics Physician | 208000000X | 036107219 | IL | |
| Pediatric Critical Care Medicine Physician | 2080P0203X | 036107219 | IL | |
| Pediatric Critical Care Medicine Physician | 2080P0203X | ME120308 | FL | Primary |
Addresses
Primary practice location
13535 Nemours Pkwy
Orlando, FL 32827-7402
Mailing address
PO Box 191
Rockland, DE 19732-0191
Phone (302) 651-6212
Other names 1
- Heather A. Christiansen
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in FL
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: Yes
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20140919001962 | FL | Practitioner - Critical Care (Intensivists) | 8325041379 | Reassigns benefits to 1 organization |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 036107219 | IL | MD | Pediatric Critical Care Medicine Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| The Nemours Foundation | Current | Accepting new patients | |
| The Nemours Foundation | Current | Accepting new patients | |
| The Nemours Foundation | Current | Accepting new patients |
Locations
807 Childrens Way
Jacksonville, FL 32207
Phone (904) 390-3600
10140 Centurion Pkwy N
Jacksonville, FL 32256
Phone (904) 697-4100
6535 Nemours Pkwy
Orlando, FL 32827
Phone (407) 567-4000
Interoperability endpoints
- hfagan49496@direct.nemours.org
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.
-
- Multi-Specialty Clinic/Center
- Jacksonville, FL
- NPI 1265585806
-
- Children's Hospital
- Wilmington, DE
- NPI 1467505073
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1147737600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1409702400000",
"number": "1992757504",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 191",
"city": "ROCKLAND",
"state": "DE",
"postal_code": "197320191",
"telephone_number": "302-651-6212",
"fax_number": "602-651-4945"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "13535 NEMOURS PKWY",
"city": "ORLANDO",
"state": "FL",
"postal_code": "328277402",
"telephone_number": "407-650-7000",
"fax_number": "407-567-5924"
}
],
"practiceLocations": [],
"basic": {
"last_name": "FAGAN",
"first_name": "HEATHER",
"middle_name": "ANN",
"credential": "MD",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2006-05-16",
"last_updated": "2014-09-03",
"status": "A"
},
"taxonomies": [
{
"code": "208000000X",
"taxonomy_group": "",
"desc": "Pediatrics",
"state": "IL",
"license": "036107219",
"primary": false
},
{
"code": "2080P0203X",
"taxonomy_group": "",
"desc": "Pediatrics, Pediatric Critical Care Medicine",
"state": "IL",
"license": "036107219",
"primary": false
},
{
"code": "2080P0203X",
"taxonomy_group": "",
"desc": "Pediatrics, Pediatric Critical Care Medicine",
"state": "FL",
"license": "ME120308",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": [
{
"first_name": "HEATHER",
"last_name": "CHRISTIANSEN",
"middle_name": "A.",
"code": "5",
"type": "Other Name"
}
]
}
Other providers in Orlando, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 3, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.