DR. DONNA MARIE HEFFERNAN M.D.
NPI 1003842287
Family Medicine in Troy, NY

Q: What is Donna Heffernan's NPI number?

The NPI number for Donna Heffernan is 1003842287. It was assigned to this individual provider in the NPPES registry on June 23, 2006.

Q: What is Donna Heffernan's specialty?

The primary specialty registered for this NPI is Family Medicine with taxonomy code 207Q00000X.

Q: When was this NPI record last updated?

The NPPES record for Donna Heffernan was last updated on February 17, 2026. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 5 months 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.

Active since June 23, 2006PECOS EnrolledAccepts Medicare Assignment

63 EAST RD, TROY, NY 12180(518) 346-3100(877) 583-1284 Get Directions Write a Review

NPPES record last updated: February 17, 2026. Verified against the NPPES registry weekly; last sync: August 09, 2026.

Record update history: Feb 5, 2025, Sep 27, 2024, May 16, 2022 (3 updates tracked since 2022).

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About Dr. Donna Marie Heffernan M.d. NPPES

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

DR. DONNA MARIE HEFFERNAN M.D. (NPI 1003842287) is an individual family medicine provider in Troy, New York, licensed in New York (227275) and active in the NPI registry since June 2006. She is enrolled in Medicare PECOS, is affiliated with St Peter's Hospital, and is a graduate of Albany Medical College Of Union University (2000).

NPPES Registry Identity

NPI1003842287

Entity TypeIndividualFemale

Primary Taxonomy207Q00000X

Provider Legal NameDR. DONNA MARIE HEFFERNANCredential: M.D.

Location Address63 EAST RDTroy, NY 12180-6860

Mailing AddressPo Box 3203Schenectady, NY 12303-0203 · (518) 346-3100 · Fax (877) 583-1284

Phone(518) 346-3100

Fax(877) 583-1284

Sole ProprietorNo

Medical School CMSAlbany Medical College Of Union UniversityGraduated 2000

Enumeration DateJune 23, 2006

Last NPPES UpdateFebruary 17, 20263 updates tracked since enumeration

NPPES CertifiedFebruary 17, 2026

✔ NPI 1003842287 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyFamily MedicineAllopathic & Osteopathic Physicians

Taxonomy Code207Q00000X

Licenses✔ Licensed in NY · 227275✔ Licensed in NY · 2272751

Definition

Family Medicine is the medical specialty which is concerned with the total health care of the individual and the family. It is the specialty in breadth which integrates the biological, clinical, and behavioral sciences. The scope of family medicine is not limited by age, sex, organ system, or disease entity.

63 EAST RD, Troy, NY 12180

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Other Identifiers 12

Other000404017001NY · Highmark

Other394892NY · Mvp

Other1003842287NY · Humana

Other200048NY · Senior Whole Health

Other74563NY · Ghi/hmo

Other000404017001NY · Bsneny

Other0007309558NY · Aetna

Medicaid02425056NY

Other1003842287NY · Tricare

Other10072104NY · Cdphp

Other7309558NY · Aetna

Other5191C1NY · Empire Bc

Medicare Participation & PECOS CMS

Medicare enrollment, assignment, and ordering and referring status from the CMS PECOS system.

Medicare Enrollment Status

✔

Enrolled in Medicare and accepts Medicare assignment

Dr. Donna Marie Heffernan M.d. is registered in PECOS and agrees to accept the Medicare-approved amount as full payment. Medicare patients are not billed beyond the standard deductible and coinsurance.

PECOS PAC ID9133265267

PECOS Enrollment IDI20091005000018

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.

Areas of Expertise CMS Part B claims 16

Services this provider delivered to Medicare fee-for-service patients, from the CMS Medicare utilization data. Higher counts generally reflect more experience with a service; care delivered outside Medicare is not included.

Residence visit for established patient with high level of medical decision making, per day, if using time, at least 60 minutes 99350

An established patient home visit is a service where a healthcare professional visits a patient's home for a check-up or treatment. The visit typically lasts for about an hour. This service is especially beneficial for patients who may have difficulty traveling to a healthcare facility.

317 services119 patients

Chronic care management services, first 20 minutes of clinical staff time directed by health care professional, per calendar month 99490

Chronic care management services involve a healthcare professional directing clinical staff in managing your chronic conditions. This includes the first 20 minutes per month of services like medication management, care coordination, and health monitoring to help improve your health and quality of life.

287 services121 patients

Chronic care management services for two or more chronic conditions, first 30 minutes provided personally by health care professional, per calendar month 99491

Chronic care management services involve a healthcare professional personally providing care for patients with two or more chronic conditions. This service, offered monthly, focuses on the first 30 minutes of care, helping manage and coordinate the patient's health needs.

85 services62 patients

Chronic care management services for two or more chronic conditions, additional 20 minutes of clinical staff time directed by health care professional, per calendar month 99439

Chronic Care Management services involve regular check-ins with healthcare professionals to manage two or more chronic conditions. It includes an additional 20 minutes of clinical staff time per month, directed by a healthcare professional, to ensure optimal health management.

69 services48 patients

Subsequent nursing facility care with high level of medical decision making, per day, if using time, at least 45 minutes 99310

A follow-up nursing facility visit is a routine check-up that typically lasts about 35 minutes. During this visit, your health status is evaluated, any changes in your condition are noted, and necessary adjustments to your care plan are made. It's an essential part of maintaining your health.

65 services21 patients

Residence visit for established patient with moderate level of medical decision making, per day, if using time, at least 40 minutes 99349

An established patient home visit is a medical appointment conducted at your home, typically lasting around 40 minutes. This service is ideal for patients who may find it difficult to travel to a healthcare facility. During this visit, a healthcare professional will evaluate your health status, manage your care, and answer any health-related questions you may have.

63 services50 patients

Advance care planning, first 30 minutes 99497

Advance care planning is a process where you discuss your healthcare preferences with your doctor. This conversation, lasting up to 30 minutes, helps ensure your wishes are respected if you're unable to communicate them in the future. It's about your care, your way.

58 services53 patients

Subsequent nursing facility care with moderate level of medical decision making, per day, if using time, at least 30 minutes 99309

A follow-up nursing facility visit per day is a daily check-in by a healthcare professional. This 25-minute visit typically involves monitoring your health progress, addressing any concerns, and adjusting treatment plans as necessary. It's a vital part of ensuring your ongoing wellbeing.

50 services19 patients

Annual wellness visit, includes a personalized prevention plan of service (pps), subsequent visit G0439

An annual wellness visit is a yearly appointment with your primary care provider to create or update a personalized prevention plan. This plan helps prevent illness based on your current health and risk factors. It's a subsequent visit, meaning it follows an initial assessment.

35 services35 patients

Transitional care management services for problem of high complexity 99496

Transitional care management services are designed to ensure a smooth transition from a hospital to home or another care setting for patients with complex health issues. These services include medication management, patient education, and coordination with healthcare providers.

22 services19 patients

Exam of neurobehavioral status, first hour 96116

An exam of neurobehavioral status is a medical procedure that evaluates your brain's functions. This includes assessing your cognitive abilities, emotional responses, and behavioral patterns. The first hour of the exam is typically dedicated to this initial evaluation.

20 services19 patients

Residence visit for new patient with high level of medical decision making, per day, if using time, at least 75 minutes 99345

A new patient home visit is a comprehensive 75-minute appointment conducted at your home. The healthcare professional will assess your health, discuss any concerns, and create a personalized care plan. It's convenient, comfortable, and tailored to your specific needs.

19 services19 patients

Chronic care management services for two or more chronic conditions, additional 30 minutes provided personally by health care professional, per calendar month 99437

Chronic care management services involve regular check-ups, medication management, and health guidance for patients with two or more long-term health conditions. This specific service provides an additional 30 minutes of personal attention from a healthcare professional each month.

18 services13 patients

Initial nursing facility care with high level of medical decision making, per day, if using time, 50 minutes or more 99306

An initial nursing facility visit is your first meeting with your healthcare team at a nursing facility. Lasting typically 45 minutes, this appointment involves a comprehensive health assessment and the creation of your personalized care plan. It's a crucial step to ensure your health and well-being.

17 services16 patients

Physician or allowed practitioner certification for medicare-covered home health services under a home health plan of care (patient not present), including contacts with home health agency and review of reports of patient status required by physicians and G0180

This is a service where a doctor or authorized practitioner certifies that you require Medicare-covered home health services. They will communicate with the home health agency and review reports on your health status to ensure you receive appropriate care. This does not involve an in-person visit.

16 services15 patients

Assessment of and care planning for patient with impaired thought processing, typically 60 minutes 99483

This service involves a thorough evaluation of your thought processes, which may be impacting your daily life. In a typical 50-minute session, a healthcare professional will assess your cognitive abilities, identify any areas of concern, and develop a personalized care plan to help improve your mental function.

13 services13 patients

Hospital Affiliations CMS Care Compare 2

Hospitals where this provider delivers care, identified from recent Medicare claims and place-of-service records.

St Peter's Hospital

Acute Care Hospitals · Albany, NY

4/5 CMS rating

OwnershipVoluntary non-profit - Private

CMS Certification Number330057

Location315 South Manning BoulevardAlbany, NY 12208 · Albany County

Emergency services Birthing friendly

Samaritan Hospital Of Troy, New York

Acute Care Hospitals · Troy, NY

3/5 CMS rating

OwnershipVoluntary non-profit - Private

CMS Certification Number330180

Location2215 Burdett AvenueTroy, NY 12180 · Rensselaer County

Emergency services Birthing friendly

Physician Visit Costs CMS claims · ZIP area

Typical Medicare office-visit costs in the 12180 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

$84.93 typical visit price

range $54.87 – $166.88

Typical copayment $21.23 (range $13.71 – $41.72)

Most-billed visit code 99203

Established Patient

$97.08 typical visit price

range $17.54 – $136.14

Typical copayment $24.27 (range $4.38 – $34.03)

Most-billed visit code 99214

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.

Reported Quality Measures

Care Plan

Percentage of patients aged 65 years and older who have an advance care plan or surrogate decision maker documented in the medical record that an advance care plan was discussed but the patient did not wish or was not able to name a surrogate decision maker…

99%81 patients4/55-star benchmark: 100%

Elder Maltreatment Screen and Follow-Up Plan

Percentage of patients aged 65 years and older with a documented elder maltreatment screen using an Elder Maltreatment Screening Tool on the date of encounter AND a documented follow-up plan on the date of the positive screen

100%72 patients5/55-star benchmark: 100%

Pneumococcal Vaccination Status for Older Adults

Percentage of patients 65 years of age and older who have ever received a pneumococcal vaccine

85%54 patients4/55-star benchmark: 100%

Preventive Care and Screening: Body Mass Index (BMI) Screening and Follow-Up Plan

Percentage of patients aged 18 years and older with a BMI documented during the current encounter or during the previous twelve months AND with a BMI outside of normal parameters, a follow-up plan is documented during the encounter or during the previous…

100%23 patients5/55-star benchmark: 100%

Preventive Care and Screening: Screening for Depression and Follow-Up Plan

Percentage of patients aged 12 years and older screened for depression on the date of the encounter using an age appropriate standardized depression screening tool AND if positive, a follow-up plan is documented on the date of the positive screen

100%26 patients5/55-star benchmark: 100%

Urinary Incontinence: Assessment of Presence or Absence of Urinary Incontinence in Women Aged 65 Years and Older

Percentage of female patients aged 65 years and older who were assessed for the presence or absence of urinary incontinence within 12 months

100%61 patients5/55-star benchmark: 100%

Providers report different measures because they deliver different services; reporting more or less information is not a reflection of quality. Star ratings appear only where CMS assigned them.

Referred Medical Equipment & Supplies CMS DME claims 10

Durable medical equipment, devices and supplies this provider ordered from DME suppliers for patients, from Medicare fee-for-service claims.

Enteral feeding supply kit; syringe fed, per day, includes but not limited to feeding/flushing syringe, administration set tubing, dressings, tape B4034

Other-Enteral and Parenteral · category OB006N

2 suppliers12 claims360 services$2.40 avg. paid by Medicare

Powered pressure reducing mattress overlay/pad, alternating, with pump, includes heavy duty E0181

DME-Other DME · category DE000N

3 suppliers13 claims13 services$11.10 avg. paid by Medicare

Powered pressure-reducing air mattress E0277

DME-Hospital Beds · category DB000N

2 suppliers12 claims12 services$93.19 avg. paid by Medicare

Portable gaseous oxygen system, rental; includes portable container, regulator, flowmeter, humidifier, cannula or mask, and tubing E0431

DME-Oxygen and Supplies · category DC000N

2 suppliers13 claims13 services$27.45 avg. paid by Medicare

Nebulizer, with compressor E0570

DME-Other DME · category DE000N

1 supplier12 claims12 services$3.69 avg. paid by Medicare

Patient lift, hydraulic or mechanical, includes any seat, sling, strap(s) or pad(s) E0630

DME-Other DME · category DE000N

1 supplier12 claims12 services$36.28 avg. paid by Medicare

Dollar amounts are the average Medicare paid the supplier per service. They are not the cost to the patient.

Other Providers at the Same Location NPPES

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

DONNA HEFFERNAN MD PLLC

Family Medicine

63 EAST RD
TROY, NY 12180

Rensselaer County (518) 346-3100

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 Donna Heffernan's NPI number?

The NPI number for Donna Heffernan is 1003842287. It was assigned to this individual provider in the NPPES registry on June 23, 2006.

Where is Donna Heffernan located?

Donna Heffernan practices at 63 East Rd, Troy, NY 12180. The listed phone number is (518) 346-3100.

What is Donna Heffernan's specialty?

The primary specialty registered for this NPI is Family Medicine with taxonomy code 207Q00000X.

Is Donna Heffernan enrolled in Medicare?

Yes. Donna Heffernan is registered in the Medicare PECOS system and accepts Medicare assignment, which means accepting the Medicare-approved amount as payment in full for covered services.

Is Donna Heffernan affiliated with any hospitals?

According to CMS data, Donna Heffernan is affiliated with St Peter's Hospital and Samaritan Hospital Of Troy, New York.

When was this NPI record last updated?

The NPPES record for Donna Heffernan was last updated on February 17, 2026. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 5 months 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.