Individual provider Active NPI

Joseph P Hermosa, M.D.

  • Internal Medicine Physician
  • Round Rock, TX
National Provider Identifier
1306885124
Registry record updated Jul 5, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
L4435 Issued in TX
Practice address
402A W Palm Valley Blvd # 350
Round Rock, TX 78664-4237
Phone
(512) 630-1969
Fax
(512) 240-5026
NPI assigned
Jun 6, 2006
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jul 5, 2020

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X L4435 TX Primary

Addresses

Primary practice location

402A W Palm Valley Blvd # 350
Round Rock, TX 78664-4237

Mailing address

402A W Palm Valley Blvd # 350
Round Rock, TX 78664-4237
Phone (512) 630-1969

Other identifiers 1

IdentifierTypeStateIssuer
162627701MedicaidTX

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TX
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
I20050801000836 TX Practitioner - Internal Medicine 3173551108 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Internal Medicine
Education
University of Texas Medical Branch at Galveston, 2000
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services

Practice addresses (Care Compare)

402 A W Palm Valley Blvd
Suite 350
Round Rock, TX 78664-4237
Phone (512) 630-1969

Hospital & facility affiliations

  • Enhabit Home Health Home health agency, Georgetown, TX, CCN 679647
  • Enhabit Home Health Home health agency, San Antonio, TX, CCN 679044

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
L4435TXMDInternal Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Tony Shallin, Mdpa Internal Medicine Past Accepting new patients
Kumar Sathianathan, Mdpa Internal Medicine Past Accepting new patients

Organizations & group practices 3

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 2

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": "1149552000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1593907200000",
    "number": "1306885124",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "402A W PALM VALLEY BLVD # 350",
            "city": "ROUND ROCK",
            "state": "TX",
            "postal_code": "786644237",
            "telephone_number": "512-630-1969",
            "fax_number": "512-240-5026"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "402A W PALM VALLEY BLVD # 350",
            "city": "ROUND ROCK",
            "state": "TX",
            "postal_code": "786644237",
            "telephone_number": "512-630-1969",
            "fax_number": "512-240-5026"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HERMOSA",
        "first_name": "JOSEPH",
        "middle_name": "P",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-06-06",
        "last_updated": "2020-07-05",
        "certification_date": "2020-07-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "TX",
            "license": "L4435",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "162627701",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Round Rock, TX

Sources for this page

Verify at the official NPI Registry.