Corinne Monique Hertsel

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

71009435A Issued in IN

Practice address

107 W Pickwick Dr Ste a
Syracuse, IN 46567-1832

Phone

(574) 457-8585

Fax

(260) 479-2913

NPI assigned

Oct 10, 2019

Last updated

Oct 10, 2019By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Other names 1

• Corinne Monique Shields Former name

Electronic endpoints 1

Medicare fee-for-service enrollment

Enrolled in IN

Eligible to order & refer

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

Green means eligible to order or refer.

Enrollment records 1

Specialty

Nurse Practitioner

Education

Other, 2019

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Kosciusko Medical Group LLCGroup PAC ID 5496809956, 41 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Kosciusko Community Hospital Hospital, Warsaw, IN, CCN 150133
• Elkhart General Hospital Hospital, Elkhart, IN, CCN 150018

Merit-based Incentive Payment System (MIPS)

Final score

90.99 of 100Reported as apm

Quality

77.41

Promoting interoperability

100

Improvement activities

40

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

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.

• Kosciusko Medical Group LLC

  • Family Medicine Physician
  • Warsaw, IN
  • NPI 1932349594
  Medicare reassignment Care Compare group NPD
• Major Hospital

  • General Acute Care Hospital
  • Shelbyville, IN
  • NPI 1174555692
  NPD (past)

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

• Elkhart General Hospital, Inc.

  • General Acute Care Hospital
  • Elkhart, IN
  • NPI 1477551489
  Care Compare affiliation
• Warsaw Health System LLC

  dba Lutheran Kosciusko Hospital

  • General Acute Care Hospital
  • Warsaw, IN
  • NPI 1164475711
  Care Compare affiliation

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

{
    "created_epoch": "1570665600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1570665600000",
    "number": "1164064119",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "107 W PICKWICK DR STE A",
            "city": "SYRACUSE",
            "state": "IN",
            "postal_code": "465671832",
            "telephone_number": "574-457-8585",
            "fax_number": "260-479-2913"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "107 W PICKWICK DR STE A",
            "city": "SYRACUSE",
            "state": "IN",
            "postal_code": "465671832",
            "telephone_number": "574-457-8585",
            "fax_number": "260-479-2913"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HERTSEL",
        "first_name": "CORINNE",
        "middle_name": "MONIQUE",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2019-10-10",
        "last_updated": "2019-10-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "163W00000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse",
            "state": "IN",
            "license": "28173822A",
            "primary": false
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "IN",
            "license": "71009435A",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "OTHERS",
            "endpointTypeDescription": "Other URL",
            "endpoint": "Syracuse",
            "affiliation": "N",
            "endpointDescription": "Office",
            "address_1": "107 W Pickwick Dr Ste A",
            "city": "Syracuse",
            "state": "IN",
            "country_code": "US",
            "postal_code": "465671832",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "first_name": "CORINNE",
            "last_name": "SHIELDS",
            "middle_name": "MONIQUE",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

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• Family Nurse Practitioner in Syracuse, IN
• Providers in Syracuse, IN by specialty
• Family Nurse Practitioner in Indiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 10, 2019; 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.
• 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.