NPIMap

Individual provider Active NPI

Bryan Jeremy Herzog, MD

  • Urology Physician
  • Loveland, CO
National Provider Identifier
1437618535
Registry record updated Aug 14, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Urology PhysicianTaxonomy code 208800000X
License
DR.0072781 Issued in CO
Practice address
2555 E 13TH St
Loveland, CO 80537-5161
Phone
(970) 810-5675
Fax
(970) 810-1899
NPI assigned
Mar 18, 2019
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 14, 2024

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Urology Physician 208800000X DR.0072781 CO Primary

Addresses

Primary practice location

2555 E 13TH St
Loveland, CO 80537-5161

Mailing address

4802 Prairie Vista Dr
Fort Collins, CO 80526-3779
Phone (917) 974-0848

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CO
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
I20240903000199 CO Practitioner - Urology 8426597618 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Urology
Education
Florida International Univ, College of Medicine, 2019
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Banner Health Physicians Colorado LLCGroup PAC ID 8921273038, 278 clinicians

Practice addresses (Care Compare)

2555 E 13TH St
Suite 230
Loveland, CO 80537-5133
Phone (970) 820-2475

Hospital & facility affiliations

  • Banner North Co Medical Center - Loveland Campus Hospital, Loveland, CO, CCN 060030
  • Banner Fort Collins Medical Center Hospital, Fort Collins, CO, CCN 060126
  • Banner North Colorado Medical Center Hospital, Greeley, CO, CCN 060001
  • Sterling Regional Medcenter Hospital, Sterling, CO, CCN 060076

Procedures performed for Medicare patients

ProcedureNumber of procedures
Prostate resection1-10

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Banner Health Physicians Colorado LLC CurrentSince Sep 9, 2024 Accepting new patients
Banner Health Physicians Colorado LLC CurrentSince Sep 9, 2024 Accepting new patients
Banner Health Physicians Colorado LLC Past Accepting new patients

Locations

1801 16th St
Ste C2B
Greeley, CO 80631
Phone (970) 810-4121

2555 E 13th St
Ste 105
Loveland, CO 80537
Phone (970) 810-0020

2555 E 13th St
Ste 230
Loveland, CO 80537
Phone (970) 203-2475

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 14

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

View all 14

NPI Registry JSON

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

{
    "created_epoch": "1552867200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1723593600000",
    "number": "1437618535",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4802 PRAIRIE VISTA DR",
            "city": "FORT COLLINS",
            "state": "CO",
            "postal_code": "805263779",
            "telephone_number": "917-974-0848"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2555 E 13TH ST",
            "city": "LOVELAND",
            "state": "CO",
            "postal_code": "805375161",
            "telephone_number": "970-810-5675",
            "fax_number": "970-810-1899"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HERZOG",
        "first_name": "BRYAN",
        "middle_name": "JEREMY",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2019-03-18",
        "last_updated": "2024-08-14",
        "certification_date": "2024-08-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208800000X",
            "taxonomy_group": "",
            "desc": "Urology",
            "state": "CO",
            "license": "DR.0072781",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Loveland, CO

Sources for this page

Verify at the official NPI Registry.