MICHAEL R HEAPHY JR. is a physician enrolled with Centers for Medicare & Medicaid Services (CMS). The enrollment date is April 13, 2018.
MICHAEL R HEAPHY JR. is a dermatology enrolled with Centers for Medicare & Medicaid Services (CMS). The organization name is MOUNTAIN WEST DERM - BLACKHART PLLC. The business address is 640 W Moana Ln, Reno, NV 89509-4903.
| NPI | 1174620496 Nation Provider Identifier (NPI) National Plan and Provider Enumeration System (NPPES) |
| PAC ID | 7416977582 PECOS Associate Control (PAC) ID Medicare Provider Enrollment and Chain/Ownership System (PECOS) |
| Professional Enrollment ID | I20180413001324 |
| Full Name | MICHAEL R HEAPHY JR. |
| Gender | M |
| Credential | MD - Medical Doctor |
| Medical School | UNIVERSITY OF TEXAS MEDICAL SCHOOL AT HOUSTON |
| Graduation Year | 1999 |
| Primary Specialty | DERMATOLOGY |
| Organization Legal Name | MOUNTAIN WEST DERM - BLACKHART PLLC |
| Group Practice PAC ID | 1153609813 |
| Number of Group Practice Members | 86 |
| Address | 640 W Moana Ln Reno NV 89509-4903 |
| Telephone | 7753240699 |
| Professional Accepts Medicare Assignment | Y - Accepts Medicare approved amount as payment in full |
| Group Accepts Medicare Assignment | Y - Accepts Medicare approved amount as payment in full |
| NPI | 1174620496 Nation Provider Identifier (NPI) National Plan and Provider Enumeration System (NPPES) |
| Provider Name | MICHAEL RILEY HEAPHY JR. |
| Address | 4814 Sparks Blvd Sparks NV 89436 |
| Classification | Dermatology - Dermatopathology |
| Taxonomy Code | 207ND0900X |
| Enumeration Date | 2006-09-20 |
| Organization Legal Name | Address | Telephone |
|---|---|---|
| MOUNTAIN WEST DERM - BLACKHART PLLC | 1700 W Riverstone Dr, Coeur D Alene, ID 83814-5683 | 2087702822 |
| MOUNTAIN WEST DERM - BLACKHART PLLC | 1807 N Hutchinson Rd, Spokane Valley, WA 99212-2444 | 5094567414 |
| MOUNTAIN WEST DERM - BLACKHART PLLC | 3640 Warren Way, Reno, NV 89509-5240 | 7753240699 |
| MOUNTAIN WEST DERM - BLACKHART PLLC | 3841 Piper St, Suite T4 020, Anchorage, AK 99508-4673 | 9076468500 |
| MOUNTAIN WEST DERM - BLACKHART PLLC | 4513 Williams Dr, Georgetown, TX 78633-1302 | 5129303909 |
| MOUNTAIN WEST DERM - BLACKHART PLLC | 5905 N Mayfair St, Suite 200, Spokane, WA 99208-1127 | 5094567414 |
| MOUNTAIN WEST DERM - BLACKHART PLLC | 640 W Moana Ln, Reno, NV 89509-4903 | 7753240699 |
| MOUNTAIN WEST DERM - BLACKHART PLLC | 7801 N Lamar Blvd, Suite D81 82, Austin, TX 78752-1016 | 5128683376 |
| Address | Telephone | Group Practice PAC ID |
|---|---|---|
| 3841 Piper St, Suite T4 020, Anchorage, AK 995084673 | 9076468500 | 1153609813 |
| 1700 W Riverstone Dr, Coeur D Alene, ID 838145683 | 2087702822 | 1153609813 |
| 640 W Moana Ln, Reno, NV 895094903 | 7753240699 | 1153609813 |
| 3640 Warren Way, Reno, NV 895095240 | 7753240699 | 1153609813 |
| 341 Nw Medical Loop, Suite 110, Roseburg, OR 974715546 | 5414402165 | 1153609813 |
| 2747 Ne Conners Ave, Bend, OR 977018738 | 5413825712 | 1153609813 |
| 4513 Williams Dr, Georgetown, TX 786331302 | 5129303909 | 1153609813 |
| 7801 N Lamar Blvd, Suite D81 82, Austin, TX 787521016 | 5128683376 | 1153609813 |
| 5905 N Mayfair St, Suite 200, Spokane, WA 992081127 | 5094567414 | 1153609813 |
| 1807 N Hutchinson Rd, Spokane Valley, WA 99212-2444 | 5094567414 | 1153609813 |
| 1125 S 2nd Ave, Suite A, Walla Walla, WA 993624118 | 5095259404 | 1153609813 |
| Organization Legal Name | MOUNTAIN WEST DERM - BLACKHART PLLC |
| Address | 640 W Moana Ln Reno NV 89509-4903 |
| Telephone | 7753240699 |
| Medical School | UNIVERSITY OF TEXAS MEDICAL SCHOOL AT HOUSTON |
| Doctor Name | Primary Specialty | Organization Legal Name | Address |
|---|---|---|---|
| Marla Kae Nmi Stahlnecker | Nurse Practitioner | Mountain West Derm - Blackhart Pllc | 1125 S 2nd Ave, Suite A, Walla Walla, WA 99362-4118 |
| Staci M Hestdalen | Dermatology | Mountain West Derm - Blackhart Pllc | 5905 N Mayfair St, Suite 200, Spokane, WA 99208-1127 |
| Alexandria Noel Staub | Physician Assistant | Mountain West Derm - Blackhart Pllc | 2747 Ne Conners Ave, Bend, OR 97701-8738 |
| Christopher R Jones Jr. | Dermatology | Mountain West Derm - Blackhart Pllc | 4513 Williams Dr, Georgetown, TX 78633-1302 |
| Tamara Lee Vandyke | Physician Assistant | Mountain West Derm - Blackhart Pllc | 607 S Maine St, Fallon, NV 89406-3801 |
| Doug Starley | Physician Assistant | Mountain West Derm - Blackhart Pllc | 640 W Moana Ln, Reno, NV 89509-4903 |
| Gretchen Korver | Dermatology | Mountain West Derm - Blackhart Pllc | 640 W Moana Ln, Reno, NV 89509-4903 |
| Mollie M Jan | Dermatology | Mountain West Derm - Blackhart Pllc | 1309 Mormon Mill Rd, Marble Falls, TX 78654-4602 |
| Michael John Housley | Physician Assistant | Mountain West Derm - Blackhart Pllc | 7733 W Emerald St, Boise, ID 83704-9020 |
| Andrea M Dominey | Dermatology | Mountain West Derm - Blackhart Pllc | 1807 N Hutchinson Rd, Spokane Valley, WA 99212-2444 |
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| Street Address | 640 W MOANA LN |
| City | RENO |
| State | NV |
| Zip Code | 89509-4903 |
| Doctor Name | Primary Specialty | Organization Legal Name | Address |
|---|---|---|---|
| Doug Starley | Physician Assistant | Mountain West Derm - Blackhart Pllc | 640 W Moana Ln, Reno, NV 89509-4903 |
| Gretchen Korver | Dermatology | Mountain West Derm - Blackhart Pllc | 640 W Moana Ln, Reno, NV 89509-4903 |
| Sarah Elizabeth Gutierrez | Physician Assistant | Mountain West Derm - Blackhart Pllc | 640 W Moana Ln, Reno, NV 89509-4903 |
| Diane M Smith | Nurse Practitioner | Mountain West Derm - Blackhart Pllc | 640 W Moana Ln, Reno, NV 89509-4903 |
| Doctor Name | Primary Specialty | Organization Legal Name | Address |
|---|---|---|---|
| Karyn Forsyth | Psychologist, Clinical | 375 Caliente St, Reno, NV 89509-2729 | |
| Michael J Spevak | Physical Therapy | Spevak Physical Therapy Nevada LLC | 3594 W Plumb Ln, Suite B, Reno, NV 89509-3087 |
| Andrew P Drymalski | Psychologist, Clinical | 3345 Thornhill Dr, Reno, NV 89509-3074 | |
| Joel Burg | Clinical Social Worker | 505 S Arlington Ave, Suite 203, Reno, NV 89509-1525 | |
| Stephanie W Dillon | Clinical Psychologist | 1065 Haskell St, Reno, NV 89509-2815 | |
| Colin B Chisholm | Clinical Social Worker | 626 Humboldt St, Reno, NV 89509-1606 | |
| Sandie W Fox | Clinical Social Worker | 505 S Arlington Ave, 212a, Reno, NV 89509-1527 | |
| John F Burgess | Podiatry | 1225 Westfield Ave, Suite 2, Reno, NV 89509-1834 | |
| Christy Lighthouse | Optometry | Eric R Kroll O D Ltd | 118 California Ave, Reno, NV 89509-1619 |
| Matthew Boland | Psychologist, Clinical | Health Psychology Associates LLC | 245 Mount Rose St, Reno, NV 89509-3355 |
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| Doctor Name | Primary Specialty | Organization Legal Name | Address |
|---|---|---|---|
| Michael R Heaphy Sr. | Dermatology | 750 W High St, Suite 300, Lima, OH 45801-2967 | |
| Michael Michael Lipsky | Chiropractic | 1325 E Thousand Oaks Blvd, Suite 104, Thousand Oaks, CA 91362-6258 | |
| Michael S Lee | Cardiovascular Disease (cardiology) | The Regents of The University of California | 757 Westwood Plz, Suite 7501, Los Angeles, CA 90095-8358 |
| Michael Michael Tang | Psychiatry | Dimock Community Health Center Inc | 45 Dimock St, Roxbury, MA 02119-1208 |
| Gregory S Heaphy | Emergency Medicine | Mercy Hospital | 144 State St, Portland, ME 04101-3776 |
| Michael Michael Alagna | Nurse Practitioner | Advocate Health and Hospitals Corporation | 9550 W 167th St, Orland Park, IL 60467-5561 |
| Michael A. Law | Optometry | 404 W College, Berryville, AR 72616-3946 | |
| Lynda S Heaphy | Nurse Practitioner | Pulmonary Associates Pa | 5750 W Thunderbird Rd, Bldg E Suite 500, Glendale, AZ 85306-4660 |
| Michael J Cox | Orthopedic Surgery | Hattiesburg Clinic, Pa | 415 S 28th Ave, Hattiesburg, MS 39401-7246 |
| John C Heaphy | Otolaryngology | Hawaii Permanente Medical Group Inc | 3288 Moanlua Rd, Honolulu, HI 96819 |
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This dataset includes 1.5 million individual physicians, and other clinicians currently enrolled in Medicare. The dataset contains general information about individual eligible professionals (EPs) such as demographic information and Medicare quality program participation. Each physician is registered with NPI, PAC ID, full name, specialty, phone, organization, hospital, address, medical school, etc.
| Data Provider | Centers for Medicare & Medicaid Services (CMS) |
| Jurisdiction | United States |