NPIMap

Individual provider Active NPI

John L Herzog Sr., MD

  • Cardiovascular Disease Physician
  • Greenville, MS
National Provider Identifier
1093734949
Registry record updated Aug 21, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Cardiovascular Disease PhysicianTaxonomy code 207RC0000X
License
09800 Issued in MS
Practice address
1421 E Union St
Greenville, MS 38703-3247
Phone
(662) 335-0183
Fax
(662) 335-7184
NPI assigned
Jul 19, 2006
Last updated
Aug 21, 2020By the provider in NPPES
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Aug 21, 2020

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Cardiovascular Disease Physician 207RC0000X 09800 MS Primary

Addresses

Primary practice location

1421 E Union St
Greenville, MS 38703-3247

Mailing address

PO Box 5368
Greenville, MS 38704-5368
Phone (662) 394-0107

Other identifiers 3

IdentifierTypeStateIssuer
060000624OtherMSMEDICARE
00123017MedicaidMS
126236001MedicaidAR

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MS
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
I20110128000684 MS Practitioner - Cardiovascular Disease (Cardiology)Practitioner - Internal Medicine 1355390964 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Cardiovascular Disease (Cardiology)Also: Internal Medicine
Education
University of Mississippi School of Medicine, 1981
Medicare assignment
May accept Medicare assignment
Group practices
Delta Medical GroupGroup PAC ID 6608775531, 48 clinicians
Delta Heart and Vascular Center, P.a.Group PAC ID 1355390063, 4 clinicians

Practice addresses (Care Compare)

1400 E Union St
Greenville, MS 38703-3246
Phone (662) 378-3783

1421 E Union St
Greenville, MS 38703-3247

1513 E Union St
Greenville, MS 38703-3249
Phone (662) 846-6034

1693 Fairgrounds Rd
Greenville, MS 38703-7810
Phone (662) 378-3783

410 E Washington St
Greenwood, MS 38930-4539
Phone (662) 219-2991

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
21.62 of 100Reported as individual
Quality
0
Improvement activities
0
Cost
72.05

Procedures performed for Medicare patients

ProcedureNumber of procedures
Coronary angioplasty and stenting1-10
Pacemaker insertion or repair18
Leg revascularization (restoring blood flow)48

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
09800MSMDCardiovascular Disease Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Delta Heart & Vascular Center, P.a. CurrentSince Oct 1, 2001 Accepting new patients
Delta Health System CurrentSince Feb 1, 2021 Accepting new patients
River Medical Healthcare LLC Current Accepting new patients
Delta Medical Group CurrentSince Jul 9, 2019 Accepting new patients
Clarksdale Hma Physican Management, LLC Past Accepting new patients
Hollandale Family Care, P.C. PastSince Jan 1, 2006 Accepting new patients
Washington County LTC, Inc. PastSince Jan 1, 2024 Accepting new patients
Delta Health System Past Accepting new patients
Delta Physician Practices Past Accepting new patients
Northern Mississippi Vascular Access Center PastSince Aug 1, 2021 Accepting new patients
Allegiance Specialty Hospital of Greenville, LLC Past Accepting new patients

Locations

785 Ohio Ave
Ste 3B
Clarksdale, MS 38614
Phone (662) 624-5026

1421 E Union St
Greenville, MS 38703
Phone (662) 335-0183

1513 E Union St
Greenville, MS 38703
Phone (601) 378-9191

1693 Fairgrounds Rd
Greenville, MS 38703
Phone (662) 378-3783

408 E Washington St
Greenwood, MS 38930
Phone (662) 219-3902

122 E Baker St
Indianola, MS 38751
Phone (662) 335-0183

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
Ms Care Center of GreenvilleGreenville, MS, CCN 255252 Skilled nursing facility Adp of the SNF Jan 1, 2024

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 12

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 12

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": "1153267200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1597968000000",
    "number": "1093734949",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 5368",
            "city": "GREENVILLE",
            "state": "MS",
            "postal_code": "387045368",
            "telephone_number": "662-394-0107",
            "fax_number": "662-335-7184"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1421 E UNION ST",
            "city": "GREENVILLE",
            "state": "MS",
            "postal_code": "387033247",
            "telephone_number": "662-335-0183",
            "fax_number": "662-335-7184"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HERZOG",
        "first_name": "JOHN",
        "middle_name": "L",
        "name_suffix": "Sr.",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-07-19",
        "last_updated": "2020-08-21",
        "certification_date": "2020-08-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207RC0000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Cardiovascular Disease",
            "state": "MS",
            "license": "09800",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE",
            "identifier": "060000624",
            "state": "MS"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00123017",
            "state": "MS"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "126236001",
            "state": "AR"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Greenville, MS

Sources for this page

Verify at the official NPI Registry.