Jill C Hertzendorf, MD

Primary specialty

Emergency Medicine PhysicianTaxonomy code 207P00000X

License

35.056454 Issued in OH

Practice address

420 N James Rd
Columbus, OH 43219-1834

Phone

(614) 257-5200

NPI assigned

Apr 11, 2006

Sex

Female

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 3

Medicare fee-for-service enrollment

Enrolled in OH

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

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

Practice roles

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.

• Genesis Emergency Physicians LLC

  • Emergency Medicine Physician
  • Zanesville, OH
  • NPI 1275773301
  NPD (past)

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

{
    "created_epoch": "1144713600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1567123200000",
    "number": "1336102037",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "420 N JAMES RD",
            "city": "COLUMBUS",
            "state": "OH",
            "postal_code": "432191834",
            "telephone_number": "614-257-5200"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "420 N JAMES RD",
            "city": "COLUMBUS",
            "state": "OH",
            "postal_code": "432191834",
            "telephone_number": "614-257-5200"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HERTZENDORF",
        "first_name": "JILL",
        "middle_name": "C",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-04-11",
        "last_updated": "2019-08-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "OH",
            "license": "35.056454",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "IND RRMEDICARE # AT GRDY",
            "identifier": "P00088048",
            "state": "OH"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0699838",
            "state": "OH"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "IND BC/BS # FOR GRADY",
            "identifier": "000000317006",
            "state": "OH"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Alexis Prager Herstein, OD, MS
• Alven Lee Herstig, DDS
• Grace Hunter Hertel, LISW
• Kathleen Hertert, MSW, LISW, CDCA
• Amanda Lynn Hertzberg, CNP
• Stacie L Hertzsch, CNP
• Jessica Herwald
• Danielle Nicole Hery, MD
• Aaron Herzberg, BS OF PHARMACY
• Alysia Courtot Herzog, MD

• Emergency Medicine Physician in Columbus, OH
• Providers in Columbus, OH by specialty
• Emergency Medicine Physician in Ohio

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

Verify at the official NPI Registry.