Gary Ronald Herzberg, MD

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

A25421 Issued in CA

Practice address

591 Swain Woods Ter
Sebastopol, CA 95472-4379

Phone

(707) 483-1802

NPI assigned

Oct 5, 2006

Last updated

Dec 30, 2015By the provider in NPPES

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

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Opted out of Medicare

Yes, effective Aug 9, 2019 through Aug 9, 2027

Medicare enrollment (NPD)

Not enrolled

Credentials

Doctor of Medicine

State licenses

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

{
    "created_epoch": "1160006400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1451433600000",
    "number": "1235225194",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "591 SWAIN WOODS TER",
            "city": "SEBASTOPOL",
            "state": "CA",
            "postal_code": "954724379"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "591 SWAIN WOODS TER",
            "city": "SEBASTOPOL",
            "state": "CA",
            "postal_code": "954724379",
            "telephone_number": "707-483-1802"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HERZBERG",
        "first_name": "GARY",
        "middle_name": "RONALD",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-10-05",
        "last_updated": "2015-12-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "CA",
            "license": "A25421",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00A254210",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Taylor Marie Heissenbuttel
• Jaime Lynn Henderson, LPCC, LMHC, LCPC
• Jeffrey Yates Hergenrather, MD
• Mira Herman, DC, LAC
• Richard Jay Hersh, M.D.
• Cori Herzig, PSY.D.
• Bryce L Hetler, DDS
• Annaliese Hettinger, MSW, PPSC
• Hill Park Integrative Medical Center (Hill Park Medical Center)
• Shanti Hill-Gauer, LCSW

• Family Medicine Physician in Sebastopol, CA
• Providers in Sebastopol, CA by specialty
• Family Medicine Physician in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 30, 2015; 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; Opt Out Affidavits.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.