Individual provider Active NPI

Jacques A Herzog, MD

  • Otology & Neurotology Physician
  • Saint Louis, MO
National Provider Identifier
1255330650
Registry record updated Apr 17, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Otology & Neurotology PhysicianTaxonomy code 207YX0901X
License
R7F68 Issued in MO
Practice address
450 N New Ballas Rd
Dept Otolaryngology, Ste 140
Saint Louis, MO 63141-6859
Phone
(314) 362-7509
Fax
(314) 453-0561
NPI assigned
Jul 18, 2005
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 17, 2025

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Specialist 174400000X R7F68 MO
Otology & Neurotology Physician 207YX0901X R7F68 MO Primary

Addresses

Primary practice location

450 N New Ballas Rd
Dept Otolaryngology, Ste 140
Saint Louis, MO 63141-6859

Mailing address

PO Box 7412011
Chicago, IL 60674-2011
Phone (314) 362-7509

Other identifiers 1

IdentifierTypeStateIssuer
202326427MedicaidMO

Electronic endpoints 1

TypeEndpointUseAffiliation
FHIR URL https://epicproxy.et0965.epichosted.com/FHIRProxy/api/FHIR/DSTU2/ Washington University

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MO
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.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20050217000085 MO Practitioner - Otolaryngology 5890747984 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Otolaryngology
Education
University of Missouri, Kansas City, School of Medicine, 1980
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Washington UniversityGroup PAC ID 9830008770, 2,968 clinicians

Practice addresses (Care Compare)

660 S Euclid Ave
Saint Louis, MO 63110-1010

660 S Euclid Ave Box
8115 Dept of Otolaryngology
Saint Louis, MO 63110-1010
Phone (314) 362-7509

660 S Euclid Ave Campus Box
Saint Louis, MO 63110-1010

660 S Euclid Campus Box
8115 Dept of Otolaryngology
St Louis, MO 63110-1010

Hospital & facility affiliations

  • Barnes-Jewish West County Hospital Hospital, Creve Coeur, MO, CCN 260162
  • Missouri Baptist Medical Center Hospital, Saint Louis, MO, CCN 260108
  • St Lukes Hospital Hospital, Chesterfield, MO, CCN 260179
  • Barnes Jewish Hospital Hospital, Saint Louis, MO, CCN 260032
  • Progress West Hospital Hospital, Ofallon, MO, CCN 260219

Merit-based Incentive Payment System (MIPS)

Final score
84.2 of 100Reported as group
Quality
71.6
Promoting interoperability
100
Improvement activities
40
Cost
75.75

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
R7F68MOMDSpecialist

Practice roles

OrganizationSpecialtyStatusNew patients
Washington University CurrentSince Sep 1, 2017 Accepting new patients
Washington University CurrentSince Sep 1, 2017 Accepting new patients
Ozarks Medical Center Past Accepting new patients
Washington University Past Accepting new patients

Locations

226 S Woods Mill Rd
Ste 58
Chesterfield, MO 63017
Phone (314) 877-2888

226 S Woods Mill Rd
Ste 58W
Chesterfield, MO 63017
Phone (314) 453-0001

660 S Euclid Ave
#8115
Saint Louis, MO 63110
Phone (314) 362-7395

1 Barnes Hospital Plz
Saint Louis, MO 63110
Phone (314) 362-9170

450 N New Ballas Rd
Saint Louis, MO 63141
Phone (314) 362-7388

450 N New Ballas Rd
Ste 140
Saint Louis, MO 63141

Organizations & group practices 4

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

Hospital & facility affiliations 5

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": "1121644800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1744848000000",
    "number": "1255330650",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 7412011",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606742011",
            "telephone_number": "314-362-7509",
            "fax_number": "314-453-0561"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "450 N NEW BALLAS RD",
            "address_2": "DEPT OTOLARYNGOLOGY, STE 140",
            "city": "SAINT LOUIS",
            "state": "MO",
            "postal_code": "631416859",
            "telephone_number": "314-362-7509",
            "fax_number": "314-453-0561"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HERZOG",
        "first_name": "JACQUES",
        "middle_name": "A",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-07-18",
        "last_updated": "2025-04-17",
        "certification_date": "2021-03-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "",
            "desc": "Specialist",
            "state": "MO",
            "license": "R7F68",
            "primary": false
        },
        {
            "code": "207YX0901X",
            "taxonomy_group": "",
            "desc": "Otolaryngology, Otology & Neurotology",
            "state": "MO",
            "license": "R7F68",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "202326427",
            "state": "MO"
        }
    ],
    "endpoints": [
        {
            "endpointType": "FHIR",
            "endpointTypeDescription": "FHIR URL",
            "endpoint": "https://epicproxy.et0965.epichosted.com/FHIRProxy/api/FHIR/DSTU2/",
            "affiliation": "Y",
            "affiliationName": "Washington University",
            "address_1": "450 N New Ballas Rd",
            "address_2": "Dept Otolaryngology, Ste 140",
            "city": "Saint Louis",
            "state": "MO",
            "country_code": "US",
            "postal_code": "631416859",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Saint Louis, MO

Sources for this page

Verify at the official NPI Registry.