RAUL HEREDIA MD
NPI 1366408213
Internal Medicine - Cardiovascular Disease in Frankfort, KY

Q: What is Raul Heredia's NPI number?

The NPI number for Raul Heredia is 1366408213. It was assigned to this individual provider in the NPPES registry on April 20, 2006.

Q: What is Raul Heredia's specialty?

The primary specialty registered for this NPI is Internal Medicine, specializing in Cardiovascular Disease, with taxonomy code 207RC0000X.

Q: When was this NPI record last updated?

The NPPES record for Raul Heredia was last updated on December 27, 2011. NPI Profile syncs with the weekly NPPES data releases published by CMS.

Active since April 20, 2006PECOS EnrolledAccepts Medicare Assignment

95.5/100

CMS Quality Rating

1002 LEAWOOD DR, FRANKFORT, KY 40601(502) 227-7188(502) 227-7379 Get Directions Write a Review

NPPES record last updated: December 27, 2011. Verified against the NPPES registry weekly; last sync: July 19, 2026.

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About Raul Heredia Md NPPES

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

RAUL HEREDIA MD (NPI 1366408213) is an individual cardiovascular disease provider in Frankfort, Kentucky, licensed in Kentucky (35532) and active in the NPI registry since April 2006. He is enrolled in Medicare PECOS, is affiliated with Baptist Health Lexington, and is a graduate of University Of Texas Medical Branch At Galveston (2000).

NPPES Registry Identity

NPI1366408213

Entity TypeIndividualMale

Primary Taxonomy207RC0000X

Provider Legal NameRAUL HEREDIACredential: MD

Location Address1002 LEAWOOD DRFrankfort, KY 40601

Mailing AddressPo Box 4168Frankfort, KY 40601 · (502) 223-5811 · Fax (502) 227-7379

Phone(502) 227-7188

Fax(502) 227-7379

Sole ProprietorNo

Medical School CMSUniversity Of Texas Medical Branch At GalvestonGraduated 2000

Enumeration DateApril 20, 2006

Last NPPES UpdateDecember 27, 2011

✔ NPI 1366408213 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyInternal Medicine · Cardiovascular DiseaseAllopathic & Osteopathic Physicians

Taxonomy Code207RC0000X

License✔ Licensed in KY · 35532

Definition

An internist who specializes in diseases of the heart and blood vessels and manages complex cardiac conditions such as heart attacks and life-threatening, abnormal heartbeat rhythms.

1002 LEAWOOD DR, Frankfort, KY 40601

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Other Identifiers 5

Other611202249KY · Ein

Other0939806KY · Alternate Medicare Pin

Medicaid64027345KY

Medicare UPINH30990

Medicare PIN1491932KY

Accepted Insurance

The full list of accepted plans is on the Insurance tab. Issuers include Ambetter from Buckeye Health Plan, Ambetter from Home State Health, Ambetter Health and more.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

Raul Heredia 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 ID7315995834

PECOS Enrollment IDI20050111000429

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 12

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, 30-39 minutes 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.

845 services378 patients

Routine electrocardiogram (ecg) using at least 12 leads with interpretation and report 93000

An electrocardiogram (ECG) is a non-invasive test that records your heart's electrical activity. Using 12 leads attached to your body, it captures data to help identify heart conditions. A doctor interprets the results and provides a report.

564 services385 patients

Injection, regadenoson, 0.1 mg J2785

Regadenoson injection, 0.1 mg, is a medication used to help visualize the heart during a stress test. It works by increasing blood flow in the arteries of the heart. It's injected into a vein and is generally well-tolerated.

220 services55 patients

Ultrasound of heart with color-depicted blood flow, rate, direction and valve function 93306

This is a heart ultrasound, also known as an echocardiogram. It uses sound waves to create pictures of your heart, showing how blood flows through it. The color depicts the blood flow's speed and direction. It also checks the heart's valves to ensure they're working properly.

152 services150 patients

Technetium tc-99m tetrofosmin, diagnostic, per study dose A9502

Technetium Tc-99m Tetrofosmin is a radiopharmaceutical used in diagnostic imaging. It helps highlight areas of concern in the heart by emitting signals captured by a special camera. This assists doctors in detecting heart conditions.

147 services76 patients

Exercise or drug-induced heart stress test with electrocardiogram (ecg) with supervision and review by physician 93015

An exercise or drug-induced heart stress test with ECG is a procedure performed by a doctor to assess how your heart responds to exertion. It involves monitoring your heart's electrical activity while you exercise or after medication is given to mimic exercise effects.

73 services70 patients

Nuclear medicine studies of heart muscle at rest and with stress and spect 78452

Nuclear medicine studies of the heart involve two parts: rest and stress. During rest, images are taken of your heart at ease. During stress, images are taken after exercise or medication-induced stress. SPECT is a special imaging technique providing 3D pictures of your heart, helping identify any issues.

71 services71 patients

New patient office or other outpatient visit, 45-59 minutes 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.

69 services69 patients

Established patient office or other outpatient visit, 20-29 minutes 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.

60 services51 patients

Electrocardiogram (ecg) 2-day continuous with review and report by health care professional 93224

An Electrocardiogram (ECG) is a non-invasive test that records the electrical activity of your heart. In a 2-day continuous ECG, sensors attached to your chest monitor your heart's rhythm over 48 hours. A healthcare professional then reviews the data to identify any irregularities.

32 services32 patients

Ultrasound of both sides of head and neck blood flow 93880

An ultrasound of the head and neck blood flow is a safe, non-invasive procedure that uses sound waves to create images of blood vessels. It helps detect abnormalities like blockages or clots, ensuring optimal blood flow.

30 services30 patients

Programming of dual lead pacemaker system 93280

Programming of a dual lead pacemaker system is a procedure to adjust your heart's pacemaker settings. This process involves a small device, called a programmer, that communicates with your pacemaker to ensure it's working optimally for your heart's needs.

16 services11 patients

Hospital Affiliations CMS Care Compare 2

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

Baptist Health Lexington

Acute Care Hospitals · Lexington, KY

4/5 CMS rating

OwnershipVoluntary non-profit - Other

CMS Certification Number180103

Location1740 Nicholasville RoadLexington, KY 40503 · Fayette County

Emergency services Birthing friendly

Frankfort Regional Medical Center

Acute Care Hospitals · Frankfort, KY

1/5 CMS rating

OwnershipProprietary

CMS Certification Number180127

Location299 Kings Daughters DriveFrankfort, KY 40601 · Franklin County

Emergency services

Physician Visit Costs CMS claims · ZIP area

Typical Medicare office-visit costs in the 40601 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

$122.77 typical visit price

range $52.76 – $162.27

Typical copayment $30.69 (range $13.19 – $40.56)

Most-billed visit code 99204

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.

95.5/100

MIPS Final ScoreMerit-based Incentive Payment System · CMS Quality Payment Program

Scored through an Alternative Payment Model

Quality

89.59

Promoting Interoperability

100

Improvement Activities

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…

95%44 patients4/55-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.

Other Providers at the Same Location NPPES

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

CAPITAL FAMILY PHYSICIANS

Physician Assistant

1002 LEAWOOD DR
FRANKFORT, KY 40601

Franklin County (502) 223-5811

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 Raul Heredia's NPI number?

The NPI number for Raul Heredia is 1366408213. It was assigned to this individual provider in the NPPES registry on April 20, 2006.

Where is Raul Heredia located?

Raul Heredia practices at 1002 Leawood Dr, Frankfort, KY 40601. The listed phone number is (502) 227-7188.

What is Raul Heredia's specialty?

The primary specialty registered for this NPI is Internal Medicine, specializing in Cardiovascular Disease, with taxonomy code 207RC0000X.

Is Raul Heredia enrolled in Medicare?

Yes. Raul Heredia 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 Raul Heredia accept?

Health plans from Ambetter Health, Ambetter from Buckeye Health Plan, Ambetter from Home State Health, Ambetter of Tennessee and Anthem Blue Cross and Blue Shield and 1 other insurer list Raul Heredia 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 Raul Heredia affiliated with any hospitals?

According to CMS data, Raul Heredia is affiliated with Baptist Health Lexington and Frankfort Regional Medical Center.

When was this NPI record last updated?

The NPPES record for Raul Heredia was last updated on December 27, 2011. NPI Profile syncs with the weekly NPPES data releases published by CMS.