Maridel Hernandez Internal Medicine PC

Primary specialty

Internal Medicine PhysicianTaxonomy code 207R00000X

License

5101012021 Issued in MI

Legal business name

MARIDEL HERNANDEZ INTERNAL MEDICINE PC

Practice address

131 Kercheval Ave
Suite 120
Grosse Pointe Farms, MI 48236-3629

Phone

(313) 640-8400

Fax

(313) 640-9232

NPI assigned

Oct 25, 2006

Organization subpart

No

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

Authorized official

Name

Dr. Maridel Hernandez, D.O.NPI 1023013711

Title

Owner Ceo

Phone

(313) 640-8400

Specialties & licenses 1

Addresses

Other identifiers 3

Medicare fee-for-service enrollment

Enrolled in MI

Enrollment records 1

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Maridel Aileen Hernandez, DO

  • Internal Medicine Physician
  • Saint Clair Shores, MI
  • NPI 1023013711
  Medicare reassignment NPD Authorized official

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

{
    "created_epoch": "1161734400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1294790400000",
    "number": "1366526378",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "131 KERCHEVAL AVE",
            "address_2": "SUITE 120",
            "city": "GROSSE POINTE FARMS",
            "state": "MI",
            "postal_code": "482363629",
            "telephone_number": "313-640-8400",
            "fax_number": "313-640-9232"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "131 KERCHEVAL AVE",
            "address_2": "SUITE 120",
            "city": "GROSSE POINTE FARMS",
            "state": "MI",
            "postal_code": "482363629",
            "telephone_number": "313-640-8400",
            "fax_number": "313-640-9232"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MARIDEL HERNANDEZ INTERNAL MEDICINE PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-10-25",
        "last_updated": "2011-01-12",
        "status": "A",
        "authorized_official_last_name": "HERNANDEZ",
        "authorized_official_first_name": "MARIDEL",
        "authorized_official_title_or_position": "OWNER CEO",
        "authorized_official_telephone_number": "313-640-8400",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "D.O."
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Internal Medicine",
            "state": "MI",
            "license": "5101012021",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS  PIN",
            "identifier": "0E02258",
            "state": "MI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD",
            "identifier": "1158213464",
            "state": "MI"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "4869383-11",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Lauri McVeigh, LPC
• Nicolo Leone, DO
• John Lloyd Loomis Jr., MD
• Scott C Loranger
• Ruth D Mannschreck, DDS
• Lea Ann Martinico, LMSW
• Karen Andrea Matron, PA
• Marina Matta, PHYSICIAN ASSISTANT
• Kathleen Anne McAvoy, M.A.
• Megan McCarren, LLMSW

• Internal Medicine Physician in Grosse Pointe Farms, MI
• Providers in Grosse Pointe Farms, MI by specialty
• Internal Medicine Physician in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 12, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.