Individual provider Active NPI

Karl Matthew Hermann, PT, PHD

  • Physical Therapist
  • College Station, TX
National Provider Identifier
1053452532
Registry record updated Nov 23, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
License
1093607 Issued in TX
Practice address
4190 State Highway 6 S
College Station, TX 77845-8964
Phone
(979) 690-1999
Fax
(979) 690-1906
NPI assigned
Feb 9, 2007
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 23, 2011

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Therapist 225100000X 1093607 TX Primary

Addresses

Primary practice location

4190 State Highway 6 S
College Station, TX 77845-8964

Mailing address

PO Box 11165
College Station, TX 77842-1165
Phone (979) 690-1999

Other identifiers 2

IdentifierTypeStateIssuer
058397302MedicaidTX
8T1290OtherTXBLUE CROSS BLUE SHIELD

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TX

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20120709000061 TX Practitioner - Physical Therapist in Private Practice 8022099910 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physical Therapist in Private Practice
Education
Other, 1986
Medicare assignment
Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

4190 State Hwy 6 S
College Station, TX 77845-8964
Phone (979) 690-1999

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
1093607TXMDPediatric Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Wellpoint Physical Therapy Services, P.C. Physical Therapist CurrentSince Sep 2, 2003 Accepting new patients

Locations

4190 State Highway 6 S
College Station, TX 77845
Phone (979) 229-5474

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 and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1170979200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1322006400000",
    "number": "1053452532",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 11165",
            "city": "COLLEGE STATION",
            "state": "TX",
            "postal_code": "778421165",
            "telephone_number": "979-690-1999",
            "fax_number": "979-690-1906"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4190 STATE HIGHWAY 6 S",
            "city": "COLLEGE STATION",
            "state": "TX",
            "postal_code": "778458964",
            "telephone_number": "979-690-1999",
            "fax_number": "979-690-1906"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HERMANN",
        "first_name": "KARL",
        "middle_name": "MATTHEW",
        "name_prefix": "Dr.",
        "credential": "PT, PHD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-02-09",
        "last_updated": "2011-11-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "TX",
            "license": "1093607",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "058397302",
            "state": "TX"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD",
            "identifier": "8T1290",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in College Station, TX

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 23, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.