NPIMap

Individual provider Active NPI

Anthony Jay Herzog, MD

  • Hospitalist Physician
  • Palm Bay, FL
National Provider Identifier
1003255019
Registry record updated May 9, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Hospitalist PhysicianTaxonomy code 208M00000X
License
ME130900 Issued in FL
Practice address
1425 Malabar Rd NE
Palm Bay, FL 32907-2506
Phone
(321) 434-8078
Fax
(321) 434-8075
NPI assigned
Jun 24, 2013
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 9, 2018

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Hospitalist Physician 208M00000X ME130900 FL Primary

Addresses

Primary practice location

1425 Malabar Rd NE
Palm Bay, FL 32907-2506

Mailing address

3300 S Fiske Blvd
Rockledge, FL 32955-4306
Phone (321) 434-8078

Other identifiers 2

IdentifierTypeStateIssuer
021034100MedicaidFL
IZ735ZOtherFLMEDICARE

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in FL
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20170718000372 FL Practitioner - Internal MedicinePractitioner - Hospitalist 4587969852 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Internal Medicine
Education
Florida State University College of Medicine, 2014
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Health First Medical Group, LLCGroup PAC ID 7416100672, 701 clinicians

Practice addresses (Care Compare)

1425 Malabar Rd NE
Palm Bay, FL 32907-2506
Phone (321) 434-8121

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

Practice roles

OrganizationSpecialtyStatusNew patients
Health First Medical Group, LLC CurrentSince Jul 17, 2017 Accepting new patients
Health First Medical Group, LLC CurrentSince Jul 17, 2017 Accepting new patients
Space Coast Medicine CurrentSince Apr 10, 2023 Accepting new patients

Locations

2428 Clearlake Rd
Bldg K
Cocoa, FL 32922
Phone (321) 368-3862

699 W Cocoa Beach Cswy
Ste 405
Cocoa Beach, FL 32931
Phone (321) 868-7272

1425 Malabar Rd NE
Palm Bay, FL 32907
Phone (321) 434-8000

3300 S Fiske Blvd
Rockledge, FL 32955
Phone (321) 434-1771

Interoperability endpoints

  • Direct secure messaging: aherzog21593@epicdirect.hf.org

Ownership & related parties

All facility ownership & control disclosures 1

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
Atlantic Shores Nursing and Rehab CenterMelbourne, FL, CCN 105904 Skilled nursing facility Operational/Managerial Control
Adp of the SNF		 May 9, 2023
May 9, 2023

Owned or controlled facilities with NPI records 1

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

Organizations & group practices 3

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

Hospital & facility affiliations 6

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1372032000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1525824000000",
    "number": "1003255019",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3300 S FISKE BLVD",
            "city": "ROCKLEDGE",
            "state": "FL",
            "postal_code": "329554306",
            "telephone_number": "321-434-8078"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1425 MALABAR RD NE",
            "city": "PALM BAY",
            "state": "FL",
            "postal_code": "329072506",
            "telephone_number": "321-434-8078",
            "fax_number": "321-434-8075"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HERZOG",
        "first_name": "ANTHONY",
        "middle_name": "JAY",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2013-06-24",
        "last_updated": "2018-05-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208M00000X",
            "taxonomy_group": "",
            "desc": "Hospitalist",
            "state": "FL",
            "license": "ME130900",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "021034100",
            "state": "FL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE",
            "identifier": "IZ735Z",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Palm Bay, FL

Sources for this page

Verify at the official NPI Registry.