Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
NPIDirectory

Brian Heckathorn, PAC

Individual provider Physician Assistant · NPI 1811666811

Brian Heckathorn, PAC is a Physician Assistant in Green Bay, Wisconsin. Qualified in 2021, 5 years ago. Practices with Fort Wayne Radiology Associates LLC, a 35-clinician group and accepts Medicare assignment.

Years since qualifying
5
In the registry since
2021
What do these letters mean?
PAC — Physician Assistant, Certified
A physician assistant holding current national certification; usually written PA-C.

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Practice location Address checks out

835 S Van Buren St
Green Bay, WI 54301-3526
Phone: (920) 433-0111
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Physician Assistant (primary) Taxonomy 363A00000X

Record details

NPI number1811666811
Entity typeIndividual (Type 1)
GenderMale
Credentials PAC
Sole proprietorNo
NPI enumeratedSeptember 13, 2021
Last updated in NPPESDecember 30, 2021
Certification dateDecember 30, 2021

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyPHYSICIAN ASSISTANT
Medical schoolOTHER
Graduated 2021 (5 years in practice)
Group practice Fort Wayne Radiology Associates Llc — 35 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount
Practice locations8 on file with Medicare

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