NPIMap

Individual provider Active NPI

Maridel Aileen Hernandez, DO

  • Internal Medicine Physician
  • Saint Clair Shores, MI
National Provider Identifier
1023013711
Registry record updated Oct 19, 2009
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
5101012021 Issued in MI
Practice address
19603 E 8 Mile Rd
Saint Clair Shores, MI 48080-1655
Phone
(586) 445-7900
Fax
(586) 445-7940
NPI assigned
Jun 17, 2005
Last updated
Oct 19, 2009By the provider in NPPES
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Oct 19, 2009

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X 5101012021 MI Primary

Addresses

Primary practice location

19603 E 8 Mile Rd
Saint Clair Shores, MI 48080-1655

Mailing address

19603 E 8 Mile Rd
Saint Clair Shores, MI 48080-1655
Phone (586) 445-7900

Other identifiers 3

IdentifierTypeStateIssuer
0E02258OtherMIBCBS PIN
4869383MedicaidMI
1158213464OtherMIBCBS OF MI

Other names 1

  • Maridel Aileen Hernandez Other name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MI
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
I20060127000359 MI Practitioner - Internal Medicine 8022032366 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Internal Medicine
Education
Michigan State University College of Osteopathic Medicine, 1993
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services

Practice addresses (Care Compare)

30140 Harper Ave
Suite 300
Saint Clair Shores, MI 48082-1610
Phone (313) 640-8400

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
91.72 of 100Reported as individual
Quality
100
Improvement activities
40
Cost
72.41

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
5101012021MIMDInternal Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Maridel Hernandez Internal Medicine PC Internal Medicine CurrentSince Dec 1, 2005 Accepting new patients

Locations

4777 E Outer Dr
Detroit, MI 48234
Phone (313) 369-5000

19603 E 8 Mile Rd
St Clair Shrs, MI 48080
Phone (586) 445-7900

30140 Harper Ave
Ste 300
St Clr Shores, MI 48082
Phone (313) 640-8400

Organizations & group practices 1

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

Hospital & facility affiliations 8

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": "1118966400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1255910400000",
    "number": "1023013711",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "19603 E 8 MILE RD",
            "city": "SAINT CLAIR SHORES",
            "state": "MI",
            "postal_code": "480801655",
            "telephone_number": "586-445-7900",
            "fax_number": "586-445-7940"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "19603 E 8 MILE RD",
            "city": "SAINT CLAIR SHORES",
            "state": "MI",
            "postal_code": "480801655",
            "telephone_number": "586-445-7900",
            "fax_number": "586-445-7940"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HERNANDEZ",
        "first_name": "MARIDEL",
        "middle_name": "AILEEN",
        "credential": "DO",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2005-06-17",
        "last_updated": "2009-10-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "MI",
            "license": "5101012021",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS PIN",
            "identifier": "0E02258",
            "state": "MI"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "4869383",
            "state": "MI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS OF MI",
            "identifier": "1158213464",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "MARIDEL",
            "last_name": "HERNANDEZ",
            "middle_name": "AILEEN",
            "credential": "D.O.",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Saint Clair Shores, MI

Sources for this page

Verify at the official NPI Registry.