Active NPI
Maura Hertzog, PA
- Physician Assistant
- Daytona Beach, FL
National Provider Identifier
1427116235
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physician Assistant
- License
- PA2015
- Practice address
- 1671 N Clyde Morris Blvd
Suite 100
Daytona Beach, FL 32117-5590 - Phone
- (386) 274-2977
- Fax
- (386) 274-2997
- NPI assigned
- Dec 5, 2006
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physician Assistant | 363A00000X | PA2015 | FL | Primary |
Addresses
Primary practice location
1671 N Clyde Morris Blvd
Suite 100
Daytona Beach, FL 32117-5590
Mailing address
1671 N Clyde Morris Blvd
Suite 100
Daytona Beach, FL 32117-5590
Phone (386) 274-2977
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| P00450773 | Other | FL | MEDICARE RAIL ROAD |
| PA2015 | Other | FL | LICENSE |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Physician Assistant
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PA2015 | FL | MD | Physician Assistant |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Orthopedic Center of Palm Beach County, LLC | Past | Accepting new patients | |
| Orthopedic Center of Palm Beach County, LLC | Past | Accepting new patients |
Organizations & group practices 2
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.
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- Specialist
- Atlantis, FL
- NPI 1114079738
-
- Orthopaedic Surgery Physician
- Atlantis, FL
- NPI 1164963252
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1165276800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1483056000000",
"number": "1427116235",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1671 N CLYDE MORRIS BLVD",
"address_2": "SUITE 100",
"city": "DAYTONA BEACH",
"state": "FL",
"postal_code": "321175590",
"telephone_number": "386-274-2977",
"fax_number": "386-274-2997"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1671 N CLYDE MORRIS BLVD",
"address_2": "SUITE 100",
"city": "DAYTONA BEACH",
"state": "FL",
"postal_code": "321175590",
"telephone_number": "386-274-2977",
"fax_number": "386-274-2997"
}
],
"practiceLocations": [],
"basic": {
"last_name": "HERTZOG",
"first_name": "MAURA",
"credential": "PA",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-12-05",
"last_updated": "2016-12-30",
"status": "A"
},
"taxonomies": [
{
"code": "363A00000X",
"taxonomy_group": "",
"desc": "Physician Assistant",
"state": "FL",
"license": "PA2015",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MEDICARE RAIL ROAD",
"identifier": "P00450773",
"state": "FL"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "LICENSE",
"identifier": "PA2015",
"state": "FL"
}
],
"endpoints": [],
"other_names": []
}Other providers in Daytona Beach, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 30, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.