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HERON BAUMGARTEN
NPI 1003226465
Surgery in Louisville, KY

Active since May 06, 2014PECOS Enrolled
91.59/100
CMS Quality Rating
231 E CHESTNUT ST, LOUISVILLE, KY 40202(502) 588-0390(502) 588-0396 Get Directions Write a Review

NPPES record last updated: August 25, 2021. Verified against the NPPES registry weekly; last sync: October 25, 2026.

About Heron Baumgarten NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

HERON BAUMGARTEN (NPI 1003226465) is an individual surgery provider in Louisville, Kentucky, licensed in Kentucky (55207) and active in the NPI registry since May 2014. She is enrolled in Medicare PECOS.

NPPES Registry Identity

NPI1003226465
Entity TypeIndividualFemale
Primary Taxonomy208600000X
Provider Legal NameHERON BAUMGARTEN
Location Address231 E CHESTNUT STLouisville, KY 40202-1821
Mailing AddressPo Box 776879Chicago, IL 60677-6879 · (502) 588-9490 · Fax (502) 272-5116
Phone(502) 588-0390
Fax(502) 588-0396
Sole ProprietorNo
Enumeration DateMay 6, 2014
Last NPPES UpdateAugust 25, 2021
NPPES CertifiedAugust 25, 2021
✔ NPI 1003226465 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 2

★ Primary SpecialtySurgeryAllopathic & Osteopathic Physicians
Taxonomy Code208600000X
License✔ Licensed in KY · 55207
Definition
A general surgeon has expertise related to the diagnosis - preoperative, operative and postoperative management - and management of complications of surgical conditions in the following areas: alimentary tract; abdomen; breast, skin and soft tissue; endocrine system; head and neck surgery; pediatric surgery; surgical critical care; surgical oncology; trauma and burns; and vascular surgery. General surgeons increasingly provide care through the use of minimally invasive and endoscopic techniques. Many general surgeons also possess expertise in transplantation surgery, plastic surgery and cardiothoracic surgery.
Also ListedStudent in an Organized Health Care Education/Training ProgramTaxonomy 390200000X
231 E CHESTNUT ST, Louisville, KY 40202
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Accepted Insurance

The full list of accepted plans is on the Insurance tab. Issuers include Ambetter from Arizona Complete Health, Ambetter Health.Insurance ›

Medicare Participation & PECOS CMS

Medicare enrollment, assignment, billing reassignment, and ordering and referring status from CMS.

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Heron Baumgarten is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

Eligible to Order & Refer✔ Part B Labs & Imaging✔ Durable Medical Equipment✔ Home Health Agency✔ Power Mobility DevicesPer the CMS Ordering and Referring file. Eligibility means Medicare pays claims that this provider orders or refers for these categories.

Medicare Billing Reassignment

Medicare enrollment records show Heron Baumgarten reassigns Medicare billing to 1 organization. The organization bills Medicare for the services this provider delivers there.

Gomez Kozar Mcelreath Smith
1,827 mi
Surgery
18653 WEDGE PARKWAY
Reno, NV 89511
  • Reassigned Medicare billing, Nevada enrollment
  • Medicare enrollment name: Gomez Kozar Mcelreath And Smith Professional Corporation
  • 41 clinicians in this Medicare group
NPI 1760409783 (775) 323-7500

Source: CMS Revalidation Reassignment List, October 2026 release. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.

Physician Visit Costs CMS claims · ZIP area

Typical Medicare office-visit costs in the 40202 ZIP code area, from fee-for-service claims. These are area statistics, not this provider’s prices; actual charges vary by service and coverage.

New Patient
$82.24 typical visit price
range $52.76 – $162.27
Typical copayment $20.56 (range $13.19 – $40.56)
Most-billed visit code 99203
Established Patient
$66.24 typical visit price
range $16.53 – $131.99
Typical copayment $16.56 (range $4.13 – $32.99)
Most-billed visit code 99213
Amounts reflect what Medicare beneficiaries in this ZIP area are typically charged for office visits. Patients with other coverage should check their individual plans.

Medicare Quality Performance CMS QPP · MIPS

Performance in the CMS Quality Payment Program: the MIPS final score across four weighted categories, and the individual quality measures reported to Medicare.

91.59/100
MIPS Final ScoreMerit-based Incentive Payment System · CMS Quality Payment Program
Scored through an Alternative Payment Model
Quality85.05
Promoting Interoperability96.88
Improvement Activities40

Other Providers at the Same Location NPPES 20

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

SHELBYE M SCHWEINHART
Pediatrics
231 E CHESTNUT ST
LOUISVILLE, KY 40202
Jefferson County (502) 588-0982
CYNTHIA ROMER FATA M.D.
Pathology (Anatomic Pathology & Clinical Pathology)
231 E CHESTNUT ST
LOUISVILLE, KY 40202
Jefferson County (502) 456-6211
OLIVIA F MITTEL MD
Pediatrics
231 E CHESTNUT ST
LOUISVILLE, KY 40202
Jefferson County (502) 629-6000
ELIZABETH LEHTO
Pediatrics (Pediatric Emergency Medicine)
231 E CHESTNUT ST
LOUISVILLE, KY 40202
Jefferson County (502) 629-6000
MICHELE NICOLE BRESLER SNOW DO
Pediatrics
231 E CHESTNUT ST
LOUISVILLE, KY 40202
Jefferson County (502) 629-6000
JESSICA EARLINE LUVISI CRNA
Nurse Anesthetist, Certified Registered
231 E CHESTNUT ST
LOUISVILLE, KY 40202
Jefferson County (502) 629-6000
TRACE ROBERTSON KIMLER
Pediatrics
231 E CHESTNUT ST
LOUISVILLE, KY 40202
Jefferson County (502) 629-6000
JACLYN SHIELDS
Nurse Practitioner (Family)
231 E CHESTNUT ST
LOUISVILLE, KY 40202
Jefferson County (502) 494-9521

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Heron Baumgarten's NPI number?

The NPI number for Heron Baumgarten is 1003226465. It was assigned to this individual provider in the NPPES registry on May 6, 2014.

Where is Heron Baumgarten located?

Heron Baumgarten practices at 231 E Chestnut St, Louisville, KY 40202. The listed phone number is (502) 588-0390.

What is Heron Baumgarten's specialty?

The primary specialty registered for this NPI is Surgery with taxonomy code 208600000X.

Is Heron Baumgarten enrolled in Medicare?

Yes. Heron Baumgarten is registered in the Medicare PECOS enrollment system.

Which organization bills Medicare for Heron Baumgarten's services?

According to the CMS Revalidation Reassignment List (October 2026 release), Heron Baumgarten reassigns Medicare benefits to Gomez Kozar Mcelreath Smith (Reno, NV). The reassignment is filed with Medicare on form CMS-855R, signed by both the clinician and the organization, and lets the organization bill Medicare and receive payment for Heron Baumgarten's services. Reassignment records can lag staffing changes; confirm current arrangements with the organization.

What insurance does Heron Baumgarten accept?

Health plans from Ambetter Health and Ambetter from Arizona Complete Health list Heron Baumgarten as in-network in at least one marketplace plan. Coverage varies by plan and year; verify with the insurer or the provider before a visit.

When was this NPI record last updated?

The NPPES record for Heron Baumgarten was last updated on August 25, 2021. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 5 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.