Gregory A Ertl, MD

Primary specialty

SpecialistTaxonomy code 174400000X

License

19732 Issued in AZ

Practice address

350 W Catalina Dr
Yuma, AZ 85364-8112

Phone

(928) 344-0650

Fax

(928) 344-3928

NPI assigned

May 24, 2005

Reactivated

Mar 29, 2006

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in AZ

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

State licenses

Interoperability endpoints

• FHIR API: https://api.platform.athenahealth.com/4374/brand/1/csg/1/fhir/r4

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

{
    "created_epoch": "1116892800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1480464000000",
    "number": "1427051184",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "350 W CATALINA DR",
            "city": "YUMA",
            "state": "AZ",
            "postal_code": "853648112",
            "telephone_number": "928-344-0650",
            "fax_number": "928-344-3928"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "350 W CATALINA DR",
            "city": "YUMA",
            "state": "AZ",
            "postal_code": "853648112",
            "telephone_number": "928-344-0650",
            "fax_number": "928-344-3928"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ERTL",
        "first_name": "GREGORY",
        "middle_name": "A",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2005-05-24",
        "last_updated": "2016-11-30",
        "deactivation_date": "2006-03-17",
        "reactivation_date": "2006-03-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "",
            "desc": "Specialist",
            "state": "AZ",
            "license": "19732",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Specialist in Yuma, AZ
• Providers in Yuma, AZ by specialty
• Specialist in Arizona

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 30, 2016; 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.