Thiebaut Thomas Herzog

Primary specialty

Pediatrics PhysicianTaxonomy code 208000000X

License

1114344058 Issued in WA

Practice address

2500 NE Neff Rd
Bend, OR 97701-6015

Phone

(541) 382-4321

NPI assigned

Mar 27, 2014

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Electronic endpoints 1

Medicare fee-for-service enrollment

Enrolled in OR

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

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.

• St. Charles Health System, Inc.

  dba St. Charles Bend

  • General Acute Care Hospital
  • Bend, OR
  • NPI 1982621447
  Medicare reassignment NPD
• St. Charles Health System, Inc.

  dba St. Charles Medical Center - Bend

  • Rehabilitation Hospital Unit
  • Bend, OR
  • NPI 1154343150
  NPD
• St. Charles Health System, Inc.

  dba Sage View at St. Charles

  • Psychiatric Hospital Unit
  • Bend, OR
  • NPI 1154506814
  NPD
• St. Charles Health System, Inc.

  dba St. Charles Family Care - Prineville

  • Rural Health Clinic/Center
  • Prineville, OR
  • NPI 1407178528
  NPD (past)
• St. Charles Health System, Inc.

  dba St. Charles Prineville

  • Critical Access Hospital
  • Prineville, OR
  • NPI 1710160445
  NPD (past)
• St. Charles Health System, Inc.

  dba St. Charles Behavioral Health

  • Clinical Social Worker
  • Bend, OR
  • NPI 1780698696
  NPD (past)

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

{
    "created_epoch": "1395878400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1667433600000",
    "number": "1114344058",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2801 N GANTENBEIN AVE",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972271623",
            "telephone_number": "503-276-6500"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2500 NE NEFF RD",
            "city": "BEND",
            "state": "OR",
            "postal_code": "977016015",
            "telephone_number": "541-382-4321"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2801 N Gantenbein Ave",
            "address_purpose": "LOCATION",
            "city": "Portland",
            "state": "OR",
            "postal_code": "972271623",
            "country_code": "US",
            "telephone_number": "503-276-6500",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "4800 Sand Point Way NE # Oc.7830",
            "address_purpose": "LOCATION",
            "city": "Seattle",
            "state": "WA",
            "postal_code": "981053901",
            "country_code": "US",
            "telephone_number": "206-987-2525",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "HERZOG",
        "first_name": "THIEBAUT",
        "middle_name": "THOMAS",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2014-03-27",
        "last_updated": "2022-11-03",
        "certification_date": "2022-04-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "WA",
            "license": "1114344058",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "therzog159686@secure.stcharleshealthcare.org",
            "affiliation": "N",
            "address_1": "2500 NE Neff Rd",
            "city": "Bend",
            "state": "OR",
            "country_code": "US",
            "postal_code": "977016015",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Natalie Renee Herrod
• Johanna Michelle Hershenson, QMHP
• Nina Claire Hersher, CSWA
• Robert Dale Hershey
• Lisa Diane Herzig, MD
• Maleah Hess
• Audrey Nicole Hester, RD, LD
• Bradley Wayne Hester, D.M.D.
• Kelli Hewitt
• Sian Jessica Heyworth, APRN-NP

• Pediatrics Physician in Bend, OR
• Providers in Bend, OR by specialty
• Pediatrics Physician in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 3, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.