NPIMap

Individual provider Active NPI

Keri Alissa Herzog, M.D.

  • Gastroenterology Physician
  • Branford, CT
National Provider Identifier
1427292614
Registry record updated Jan 12, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Gastroenterology PhysicianTaxonomy code 207RG0100X
License
54855 Issued in CT
Practice address
1224 Main St
Branford, CT 06405-3778
Phone
(203) 481-0315
Fax
(203) 488-6945
NPI assigned
May 1, 2009
Last updated
Jan 12, 2024By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 12, 2024

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Student in an Organized Health Care Education/Training Program 390200000X
Gastroenterology Physician 207RG0100X 54855 CT Primary

Addresses

Primary practice location

1224 Main St
Branford, CT 06405-3778

Mailing address

687 Main St
Branford, CT 06405-3612
Phone (203) 481-7050

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CT
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20160708001075 CT Practitioner - GastroenterologyPractitioner - Internal Medicine 7810289022 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
GastroenterologyAlso: Internal Medicine
Education
Other, 2009
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Digestive Disease Associates LLCGroup PAC ID 5395644512, 8 clinicians

Practice addresses (Care Compare)

300 Seaside Ave
Milford, CT 06460-4603
Phone (203) 876-4000

5 Pequot Park Rd
Westbrook, CT 06498-2856

687 Main St
Branford, CT 06405-3612
Phone (203) 481-0315

849 Boston Post Rd
Suite 205
Milford, CT 06460-3537
Phone (203) 481-0315

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Colonoscopy65
Upper gastrointestinal (GI) endoscopy for acid reflux57

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
54855CTMDGastroenterology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Northeast Medical Group, Inc. CurrentSince Dec 1, 2021 Accepting new patients
Digestive Disease Associates, LLC Gastroenterology CurrentSince Jul 1, 2016 Accepting new patients
Northeast Medical Group, Inc CurrentSince Dec 1, 2021 Accepting new patients
Digestive Disease Associates Endoscopy Suite, LLC Current Accepting new patients

Locations

1224 Main St
Branford, CT 06405
Phone (203) 481-0315

229 Montowese St
Branford, CT 06405
Phone (203) 481-0315

687 Main St
Branford, CT 06405
Phone (203) 315-7070

849 Boston Post Rd
Ste 205
Milford, CT 06460
Phone (203) 481-0315

95 Armory Rd
Stratford, CT 06614
Phone (203) 384-3388

Interoperability endpoints

  • Direct secure messaging: kherzog337268@direct.ynhh.org

Organizations & group practices 4

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 6

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": "1241136000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1705017600000",
    "number": "1427292614",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "687 MAIN ST",
            "city": "BRANFORD",
            "state": "CT",
            "postal_code": "064053612",
            "telephone_number": "203-481-7050",
            "fax_number": "203-488-6945"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1224 MAIN ST",
            "city": "BRANFORD",
            "state": "CT",
            "postal_code": "064053778",
            "telephone_number": "203-481-0315",
            "fax_number": "203-488-6945"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HERZOG",
        "first_name": "KERI",
        "middle_name": "ALISSA",
        "name_prefix": "Ms.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2009-05-01",
        "last_updated": "2024-01-12",
        "certification_date": "2024-01-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207RG0100X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Gastroenterology",
            "state": "CT",
            "license": "54855",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Branford, CT

Sources for this page

Verify at the official NPI Registry.