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Ellen K Heyneman

Psychiatry & Neurology

Allopathic & Osteopathic Physicians

3020 Childrens Way, Mail Code 5018, San Diego, CA 92123-4223

PECOS Enrollment

This provider is enrolled in PECOS as ELLEN HEYNEMAN.

Based on the most recent information from CMS, provider Ellen K Heyneman is legally eligible to order and refer claims for DME and PMD services only.

Part B
Medicare Part B
Not Enrolled
HHA
Home Health Agency
Not Enrolled
DME
Durable Medical Equipment
Enrolled
PMD
Power Mobility Device
Enrolled

CMS last updated its PECOS records yesterday at 8:18 PM.

Profile Details

Provider ID
1598797847
Provider Type
Individual
Full Name
Heyneman, Ellen K
Title
Dr.
Credential
M.D.

Gender
Female
Sole Proprietor
No
Enumeration Date
7/7/2006
Last Updated
10/15/2015

Contact Information

Practice Location

3020 Childrens Way, Mail Code 5018, San Diego, CA 92123-4223

(858) 966-4935

(858) 966-7525

Mailing Location

3020 Childrens Way, Mail Code 5018, San Diego, CA 92123-4223

(858) 966-4935

(858) 966-7525

Provider Taxonomies

Code	Description	License
Code 2084P0804X Primary	Description Psychiatry & Neurology Allopathic & Osteopathic Physicians	License G68996 California
Code 208000000X	Description Pediatrics Allopathic & Osteopathic Physicians	License G68996 California
Code 2084P0800X	Description Psychiatry & Neurology Allopathic & Osteopathic Physicians	License G68996 California

Provider Identifiers

ID	Description	Issuer
ID 00G689960	Description Medicaid	Issuer Unlisted California

Ellen K Heyneman

PECOS Enrollment

Profile Details

Contact Information

Practice Location

Mailing Location

Provider Taxonomies

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Description

License

Code

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License

Code

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Provider Identifiers

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Description

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