Individual provider Active NPI

Charles A Herzog, MD

  • Cardiovascular Disease Physician
  • Minneapolis, MN
National Provider Identifier
1417996588
Registry record updated Nov 1, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Cardiovascular Disease PhysicianTaxonomy code 207RC0000X
License
25009 Issued in MN
Practice address
715 S 8TH St
Minneapolis, MN 55404-1210
Phone
(612) 873-6963
NPI assigned
Jun 5, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 1, 2023

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Cardiovascular Disease Physician 207RC0000X 25009 MN Primary

Addresses

Primary practice location

715 S 8TH St
Minneapolis, MN 55404-1210

Mailing address

701 Park Ave
Minneapolis, MN 55415-1623
Phone (612) 873-3000

Other practice location 1

701 Park Ave
Minneapolis, MN 55415-1623
Phone (612) 873-3000

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MN
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
I20100420000462 MN Practitioner - Cardiovascular Disease (Cardiology)Practitioner - Internal Medicine 9739216920 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Cardiovascular Disease (Cardiology)Also: Internal Medicine
Education
University of Rochester School of Medicine and Dentistry, 1978
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Hennepin Healthcare System IncGroup PAC ID 4789684861, 905 clinicians

Practice addresses (Care Compare)

2810 Nicollet Ave
Minneapolis, MN 55408-4708
Phone (612) 873-6963

701 Park Ave
Minneapolis, MN 55415-1623
Phone (612) 873-6963

7650 Zane Ave N
Brooklyn Park, MN 55443-3151
Phone (612) 873-6963

790 W 66TH St
Richfield, MN 55423-2203
Phone (612) 873-6963

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
92.67 of 100Reported as group
Quality
74.5
Promoting interoperability
100
Improvement activities
40
Cost
72.86

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Hennepin Healthcare System Inc CurrentSince Jan 1, 2012 Accepting new patients
Hennepin Healthcare System, Inc CurrentSince Jan 1, 2012 Accepting new patients
Hennepin Healthcare System, Inc Current Accepting new patients

Locations

914 S 8th St
Ste D4
Minneapolis, MN 55404
Phone (612) 347-3744

715 S 8th St
Minneapolis, MN 55404
Phone (612) 873-6010

701 Park Ave
Ste 350
Minneapolis, MN 55415

701 Park Ave
Minneapolis, MN 55415
Phone (612) 873-6005

914 S 8th St
#D4
Minneapolis, MN 55404
Phone (612) 347-6450

701 Park Ave
#O5
Minneapolis, MN 55415
Phone (612) 873-2875

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 1

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": "1149465600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1698796800000",
    "number": "1417996588",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "701 PARK AVE",
            "city": "MINNEAPOLIS",
            "state": "MN",
            "postal_code": "554151623",
            "telephone_number": "612-873-3000"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "715 S 8TH ST",
            "city": "MINNEAPOLIS",
            "state": "MN",
            "postal_code": "554041210",
            "telephone_number": "612-873-6963"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "701 Park Ave",
            "address_purpose": "LOCATION",
            "city": "Minneapolis",
            "state": "MN",
            "postal_code": "554151623",
            "country_code": "US",
            "telephone_number": "612-873-3000",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "HERZOG",
        "first_name": "CHARLES",
        "middle_name": "A",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-06-05",
        "last_updated": "2023-11-01",
        "certification_date": "2023-10-31",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207RC0000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Cardiovascular Disease",
            "state": "MN",
            "license": "25009",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Minneapolis, MN

Sources for this page

Verify at the official NPI Registry.