Individual provider Active NPI

Ronald D Hertz, DO

  • Internal Medicine Physician
  • Grosse Pointe Woods, MI
National Provider Identifier
1053304816
Registry record updated Apr 16, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
5101010791 Issued in MI
Practice address
19251 Mack Ave
Grosse Pointe Woods, MI 48236-2893
Phone
(313) 343-3749
Fax
(313) 343-7921
NPI assigned
Aug 26, 2005
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 16, 2021

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Adolescent Medicine (Internal Medicine) Physician 207RA0000X 5101010791 MI
Pediatrics Physician 208000000X 5101010791 MI
Internal Medicine Physician 207R00000X 5101010791 MI Primary

Addresses

Primary practice location

19251 Mack Ave
Grosse Pointe Woods, MI 48236-2893

Mailing address

22201 Moross
270
Detroit, MI 48236-1136
Phone (313) 343-7280

Other identifiers 1

IdentifierTypeStateIssuer
4435427MedicaidMI

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20081128000104 MI Practitioner - Internal MedicinePractitioner - Pediatric Medicine 9638239288 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Internal MedicineAlso: Pediatric Medicine
Education
New York Medical College, 1989
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Henry Ford Health St. John HospitalGroup PAC ID 3173424082, 332 clinicians

Practice addresses (Care Compare)

19251 Mack Ave
Suite 333
Grosse Pointe Woods, MI 48236-2898
Phone (313) 343-7280

22101 Moross Rd
Detroit, MI 48236-2148
Phone (586) 753-0011

22201 Moross Rd
Detroit, MI 48236-2166

Hospital & facility affiliations

  • Henry Ford Health St John Hospital Hospital, Detroit, MI, CCN 230165
  • Henry Ford Health Hospital Hospital, Detroit, MI, CCN 230053

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
5101010791MIMDAdolescent Medicine (Internal Medicine) Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Henry Ford Health St. John Hospital Current Accepting new patients
Pathology Specialists of Southeast Michigan PC Current Accepting new patients
Henry Ford Health St. John Hospital Internal Medicine CurrentSince Apr 1, 2002 Accepting new patients
Henry Ford Health St. John Hospital CurrentSince Apr 1, 2002 Accepting new patients
Emergency Department Physicians, P.C. Past Accepting new patients

Locations

22101 Moross Rd
Detroit, MI 48236
Phone (313) 343-3248

22201 Moross Rd
Ste 270
Grosse Pointe, MI 48236
Phone (313) 343-3481

22201 Moross Rd
Ste 70
Grosse Pointe, MI 48236
Phone (313) 343-3700

22201 Moross Rd
Ste 50
Grosse Pointe Woods, MI 48236
Phone (313) 343-7774

19251 Mack Ave
Ste 333
Grosse Pointe Woods, MI 48236
Phone (313) 343-7280

19251 Mack Ave
Grosse Pointe Woods, MI 48236
Phone (313) 343-1370

17900 23 Mile Rd
Ste 101
Macomb, MI 48044
Phone (586) 868-9010

27351 Dequindre Rd
Madison Hts, MI 48071
Phone (248) 967-7000

1135 W University Dr
Ste 355
Rochester Hills, MI 48307
Phone (248) 680-8060

21000 E 12 Mile Rd
Ste 105
St Clr Shores, MI 48081
Phone (586) 498-3606

45634 Schoenherr Rd
Utica, MI 48315
Phone (586) 532-8440

28000 Dequindre Rd
Warren, MI 48092
Phone (586) 743-0944

Organizations & group practices 6

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 2

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": "1125014400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1618531200000",
    "number": "1053304816",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "22201 MOROSS",
            "address_2": "270",
            "city": "DETROIT",
            "state": "MI",
            "postal_code": "482361136",
            "telephone_number": "313-343-7280",
            "fax_number": "313-343-7921"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "19251 MACK AVE",
            "city": "GROSSE POINTE WOODS",
            "state": "MI",
            "postal_code": "482362893",
            "telephone_number": "313-343-3749",
            "fax_number": "313-343-7921"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HERTZ",
        "first_name": "RONALD",
        "middle_name": "D",
        "name_prefix": "Dr.",
        "credential": "DO",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-08-26",
        "last_updated": "2021-04-16",
        "certification_date": "2021-04-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207RA0000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Adolescent Medicine",
            "state": "MI",
            "license": "5101010791",
            "primary": false
        },
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "MI",
            "license": "5101010791",
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "MI",
            "license": "5101010791",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "4435427",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Grosse Pointe Woods, MI

Sources for this page

Verify at the official NPI Registry.