Corinne Monique Hertsel
Individual provider Active NPI Family Nurse Practitioner · Syracuse, IN
NPI 1164064119 · NPPES record last updated Oct 10, 2019
Key facts
- NPI
- 1164064119
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Family Nurse Practitioner 363LF0000X
- License
- 71009435A (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
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 2
Hospital & facility affiliations 2
Medicare Care Compare profile
- Specialty
- Nurse Practitioner
- Education
- Other, 2019
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- Kosciusko Medical Group LLC
Practice addresses (Care Compare)
1205 Provident Dr a
Warsaw, IN 46580-3265
Phone (574) 269-8383
1275 Provident Dr
Warsaw, IN 46580-3265
Phone (574) 269-4026
Hospital & facility affiliations
- Kosciusko Community Hospital
- Elkhart General Hospital
Merit-based Incentive Payment System (MIPS)
- Final score
- 90.99 of 100
- Quality
- 77.41
- Promoting interoperability
- 100
- Improvement activities
- 40
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in IN
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: No
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20191120000801 | IN | Practitioner - Nurse Practitioner | 5193157766 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Nurse Practitioner
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 71009435A | IN | MD | Family Nurse Practitioner |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Kosciusko Medical Group LLC | Family | Current |
Accepting new patients |
| Major Hospital | Past | Accepting new patients |
Locations
515 E Main St
Mentone, IN 46539
Phone (219) 353-7561
614 N Main St
North Webster, IN 46555
Phone (574) 834-7677
1904 Lake Ave
Plymouth, IN 46563
Phone (574) 214-7504
107 W Pickwick Dr
Ste A
Syracuse, IN 46567
Phone (574) 457-8585
2235 Dubois Dr
Warsaw, IN 46580
Phone (260) 423-2567
1205 Provident Dr
#A
Warsaw, IN 46580
Phone (574) 269-8383
902 Provident Dr
Ste B
Warsaw, IN 46580
Phone (574) 269-8319
902 Provident Dr
Ste A
Warsaw, IN 46580
Phone (574) 269-8338
1540 Provident Dr
Warsaw, IN 46580
Phone (219) 372-7637
1210 Provident Dr
Warsaw, IN 46580
Phone (219) 268-4300
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Registered Nurse | 163W00000X | 28173822A | IN | |
| Family Nurse Practitioner | 363LF0000X | 71009435A | IN | Yes |
Addresses
Primary practice location
107 W Pickwick Dr Ste a
Syracuse, IN 46567-1832
Mailing address
107 W Pickwick Dr Ste a
Syracuse, IN 46567-1832
Phone (574) 457-8585
Other names
- Corinne Monique Shields
Electronic endpoints
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| Other URL | Syracuse |
Other providers in Syracuse, IN
- Stephanie S Gerber
- Tonna Gilson
- Tiffany M Gordon
- Goshen Health System, Inc
- Maria Valeria Guzman
- Hook-Superx LLC
- Robin Darlene Huffman
- Jamie Jacobs
- James R. Thwaits LLC
- Johnson Memorial Hospital
All providers in Syracuse, IN · Family Nurse Practitioner in Indiana
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Oct 10, 2019. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.