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TIMOTHY JAMES HEFFRON MD
NPI 1194769752
Otolaryngology in Raleigh, NC

Active since June 15, 2006PECOS EnrolledAccepts Medicare Assignment
10880 DURANT RD STE 124, RALEIGH, NC 27614(919) 790-2255(919) 954-1584 Get Directions Write a Review

NPPES record last updated: January 29, 2019. Verified against the NPPES registry weekly; last sync: August 09, 2026.

About Timothy James Heffron Md NPPES

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

TIMOTHY JAMES HEFFRON MD (NPI 1194769752) is an individual otolaryngology provider in Raleigh, North Carolina, licensed in North Carolina (200001595) and active in the NPI registry since June 2006. He is enrolled in Medicare PECOS, is affiliated with The Outer Banks Hospital, Inc, and is a graduate of Jefferson Medical College Of Thomas Jefferson University (1976).

NPPES Registry Identity

NPI1194769752
Entity TypeIndividualMale
Primary Taxonomy207Y00000X
Provider Legal NameTIMOTHY JAMES HEFFRONCredential: MD
Location Address10880 DURANT RD STE 124Raleigh, NC 27614-6629
Mailing Address10880 Durant Rd Ste 124Raleigh, NC 27614-6629 · (919) 790-2255 · Fax (919) 954-1584
Phone(919) 790-2255
Fax(919) 954-1584
Sole ProprietorNo
Medical School CMSJefferson Medical College Of Thomas Jefferson UniversityGraduated 1976
Enumeration DateJune 15, 2006
Last NPPES UpdateJanuary 29, 2019
✔ NPI 1194769752 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyOtolaryngologyAllopathic & Osteopathic Physicians
Taxonomy Code207Y00000X
License✔ Licensed in NC · 200001595
Definition
An otolaryngologist-head and neck surgeon provides comprehensive medical and surgical care for patients with diseases and disorders that affect the ears, nose, throat, the respiratory and upper alimentary systems and related structures of the head and neck. An otolaryngologist diagnoses and provides medical and/or surgical therapy or prevention of diseases, allergies, neoplasms, deformities, disorders and/or injuries of the ears, nose, sinuses, throat, respiratory and upper alimentary systems, face, jaws and the other head and neck systems. Head and neck oncology, facial plastic and reconstructive surgery and the treatment of disorders of hearing and voice are fundamental areas of expertise.
10880 DURANT RD STE 124, Raleigh, NC 27614
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Accepted Insurance

The full list of accepted plans is on the Insurance tab. Issuers include Blue Cross and Blue Shield of NC, UnitedHealthcare.Insurance ›

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

Timothy James Heffron Md 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 ID3476653742
PECOS Enrollment IDI20070716000535
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 5

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.

Established patient office or other outpatient visit with moderate level of decision making, if using time, 30 minutes or more 99214
This is a routine check-up for patients who have previously visited our clinic. It involves a comprehensive review of your health and any ongoing treatments. The consultation lasts between 30-39 minutes, allowing enough time to discuss any concerns.
107 services82 patients
Established patient office or other outpatient visit with low level od decision making, if using time, 20 minutes or more 99213
This is a routine visit for patients who have already been seen by the healthcare provider. During this approximately 20-29 minute appointment, your health status will be evaluated and any necessary treatments or tests will be discussed. It's a chance to address any health concerns you may have.
75 services53 patients
New patient office or other outpatient visit with low level of medical decision making, if using time, 30 minutes or more 99203
This service involves an initial office or outpatient visit for a new patient. The healthcare professional will spend 30-44 minutes understanding your health history, current issues, and discussing possible treatment plans. It's a comprehensive evaluation to start your healthcare journey.
43 services43 patients
New patient office or other outpatient visit with moderate level of medical decision making, if using time, 45 minutes or more 99204
This is a first-time office or outpatient visit lasting between 45-59 minutes. The healthcare provider evaluates your health, discusses your medical history, and may suggest further tests or treatments. It's an opportunity to ask questions and understand your health better.
35 services35 patients
Diagnostic exam of nasal passages using an endoscope 31231
A diagnostic exam of nasal passages using an endoscope is a non-invasive procedure. A small, flexible tube with a light and camera at the end, called an endoscope, is inserted into the nose. This allows the doctor to view the nasal passages and sinuses, helping to identify any issues.
34 services26 patients

Hospital Affiliations CMS Care Compare

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

The Outer Banks Hospital, Inc

Critical Access Hospitals · Nags Head, NC
4/5 CMS rating
OwnershipVoluntary non-profit - Private
CMS Certification Number341324
Location4800 South Croatan HighwayNags Head, NC 27959 · Dare County
Emergency services Birthing friendly

Physician Visit Costs CMS claims · ZIP area

Typical Medicare office-visit costs in the 27614 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
$125.01 typical visit price
range $54.12 – $165.09
Typical copayment $31.25 (range $13.53 – $41.27)
Most-billed visit code 99204
Established Patient
$67.72 typical visit price
range $17.21 – $134.61
Typical copayment $16.93 (range $4.30 – $33.65)
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.

Reported Quality Measures

e-Prescribing
At least one permissible prescription written by the MIPS eligible clinician is queried for a drug formulary and transmitted electronically using certified EHR technology.
92%976 patients3/55-star benchmark: 99%
Medication Reconciliation
The MIPS eligible clinician performs medication reconciliation for at least one transition of care in which the patient is transitioned into the care of the MIPS eligible clinician.
100%492 patients5/55-star benchmark: 100%
Patient-Specific Education
The MIPS eligible clinician must use clinically relevant information from CEHRT to identify patient-specific educational resources and provide access to those materials to at least one unique patient seen by the MIPS eligible clinician.
42%1,492 patients2/55-star benchmark: 97%
Provide Patient Access
At least one patient seen by the MIPS eligible clinician during the performance period is provided timely access to view online, download, and transmit to a third party their health information subject to the MIPS eligible clinician's discretion to withhold…
90%1,492 patients4/55-star benchmark: 100%
Secure Messaging
For at least one unique patient seen by the MIPS eligible clinician during the performance period, a secure message was sent using the electronic messaging function of CEHRT to the patient (or the patient-authorized representative), or in response to a secure…
3%1,492 patients1/55-star benchmark: 89%
View, Download, or Transmit (VDT)
At least one patient seen by the MIPS eligible clinician during the performance period (or patient-authorized representative) views, downloads or transmits their health information to a third party during the performance period.
33%1,492 patients
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.

Other Providers at the Same Location NPPES 2

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

CAROLINA EAR NOSE & THROAT PA
Otolaryngology
10880 DURANT RD STE 124
RALEIGH, NC 27614
Wake County (919) 790-2255
KATHLEEN B BERRY M.S.CCC-A
Audiologist
10880 DURANT RD STE 124
RALEIGH, NC 27614
Wake County (919) 790-2255

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 Timothy Heffron's NPI number?

The NPI number for Timothy Heffron is 1194769752. It was assigned to this individual provider in the NPPES registry on June 15, 2006.

Where is Timothy Heffron located?

Timothy Heffron practices at 10880 Durant Rd Ste 124, Raleigh, NC 27614. The listed phone number is (919) 790-2255.

What is Timothy Heffron's specialty?

The primary specialty registered for this NPI is Otolaryngology with taxonomy code 207Y00000X.

Is Timothy Heffron enrolled in Medicare?

Yes. Timothy Heffron 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.

What insurance does Timothy Heffron accept?

Health plans from Blue Cross and Blue Shield of NC and UnitedHealthcare list Timothy Heffron 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.

Is Timothy Heffron affiliated with any hospitals?

According to CMS data, Timothy Heffron is affiliated with The Outer Banks Hospital, Inc.

When was this NPI record last updated?

The NPPES record for Timothy Heffron was last updated on January 29, 2019. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 7 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.