Individual provider Active NPI

Angel Wilfredo Hernandez, MD

  • Neurology with Special Qualifications in Child Neurology Physician
  • St Petersburg, FL
National Provider Identifier
1457444531
Registry record updated Jan 10, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Neurology with Special Qualifications in Child Neurology PhysicianTaxonomy code 2084N0402X
License
ME164141 Issued in FL
Practice address
501 6TH Ave S
Saint Petersburg, FL 33701-4634
Phone
(727) 898-7451
NPI assigned
Oct 2, 2006
Last updated
Jan 10, 2024By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 10, 2024

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Neurology with Special Qualifications in Child Neurology Physician 2084N0402X 4301065634 MI
Neurology with Special Qualifications in Child Neurology Physician 2084N0402X 32763 NE
Neurology with Special Qualifications in Child Neurology Physician 2084N0402X ME164141 FL Primary

Addresses

Primary practice location

501 6TH Ave S
Saint Petersburg, FL 33701-4634

Mailing address

501 6TH Ave S
Saint Petersburg, FL 33701-4634
Phone (727) 898-7451

Other practice location 1

4014 Leavenworth St
Omaha, NE 68105-1053
Phone (402) 559-5208

Other practice location 2

1600 S 48th St
Lincoln, NE 68506-1283
Phone (402) 481-5791

Other practice location 3

35 Michigan St NE Ste 3003
Grand Rapids, MI 49503-2528
Phone (616) 267-2500

Other names 1

  • Angel Wilfredo Hernandez Other name

Electronic endpoints 3

TypeEndpointUseAffiliation
Direct Messaging Address direct@direct.bronsonhg.org Direct Bronson Healthcare Group
Direct Messaging Address ahernandez143721@epic00.shdirect.org
FHIR URL https://epicarr02.spectrumhealth.org/EpicFHIR/api/FHIR/DSTU2/

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TX, MI, FL3 enrollments
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 3

Enrollment IDStateProvider typePAC IDDetails
I20031218000601 TX Practitioner - NeurologyPractitioner - Pediatric Medicine 0749187516 Reassigns benefits to 2 organizations
I20161208000403 MI Practitioner - Pediatric MedicinePractitioner - Neurology 0749187516 Reassigns benefits to 3 organizations
I20240112004172 FL Practitioner - Neurology 0749187516 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Neurology
Education
Ponce School of Medicine, 1995
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Pediatric Physician Services, Inc.Group PAC ID 7113989849, 200 clinicians

Practice addresses (Care Compare)

601 5TH St S
Suite 5
St Petersburg, FL 33701-4804
Phone (727) 727-4429

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
32763NEMDNeurology with Special Qualifications in Child Neurology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Cook Children's Physician Network CurrentSince Jun 2, 2008 Accepting new patients
Spectrum Health Primary Care Partners CurrentSince Feb 20, 2017 Accepting new patients
Bronson Methodist Hospital Neurology CurrentSince Apr 26, 2017 Accepting new patients
Creek Nation Hospital & Clinics CurrentSince Jun 16, 2021 Accepting new patients
Lakeland Medical Practices CurrentSince Sep 11, 2020 Accepting new patients
Lakeland Medical Practices CurrentSince Sep 11, 2020 Accepting new patients
Spectrum Health Primary Care Partners CurrentSince Feb 20, 2017 Accepting new patients
Cook Children's Physician Network CurrentSince Jun 2, 2008 Accepting new patients
Pediatric Physician Services, Inc. CurrentSince Jan 8, 2024 Accepting new patients
Creek Nation Hospital & Clinics CurrentSince Jun 16, 2021 Accepting new patients

Locations

501 6th Ave S
St Petersburg, FL 33701
Phone (727) 344-6060

601 5th St S
St Petersburg, FL 33701
Phone (727) 767-3333

601 5th St S
Ste 5
St Petersburg, FL 33701
Phone (727) 727-4429

100 Michigan St NE
#845
Grand Rapids, MI 49503
Phone (616) 391-8242

35 Michigan St NE
Ste 3003
Grand Rapids, MI 49503
Phone (616) 267-2200

601 John St
Kalamazoo, MI 49007
Phone (269) 341-7100

601 John St
Ste M-124
Kalamazoo, MI 49007
Phone (269) 341-7500

4444 Kalamazoo Ave SE
Ste 200
Kentwood, MI 49508
Phone (616) 391-5600

31 N Saint Joseph Ave
Niles, MI 49120
Phone (269) 428-2417

1234 Napier Ave
Saint Joseph, MI 49085
Phone (269) 982-4941

3950 Hollywood Rd
Ste 280
Saint Joseph, MI 49085
Phone (269) 408-0990

1105 Sixth St
Traverse City, MI 49684
Phone (231) 922-9000

550 Munson Ave
Ste 202
Traverse City, MI 49686
Phone (231) 935-7548

10109 E 79th St
Tulsa, OK 74133
Phone (888) 552-6760

Dept 1467
Tulsa, OK 74182

801 7th Ave
Ft Worth, TX 76104
Phone (682) 885-4054

901 7th Ave
Ft Worth, TX 76104
Phone (682) 885-1050

136 El Chico Trl
Ste 102
Willow Park, TX 76087
Phone (817) 441-5412

Interoperability endpoints

  • Direct secure messaging: ahernandez1173613@direct.hopkinsmedicine.org
  • Direct secure messaging: ahernandez143721@epic00.corewelldirect.org
  • Direct secure messaging: ahernandez143721@epic00.shdirect.org
  • Direct secure messaging: direct@direct.bronsonhg.org

Organizations & group practices 10

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.

NPI Registry JSON

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

{
    "created_epoch": "1159747200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1704844800000",
    "number": "1457444531",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "501 6TH AVE S",
            "city": "SAINT PETERSBURG",
            "state": "FL",
            "postal_code": "337014634",
            "telephone_number": "727-898-7451"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "501 6TH AVE S",
            "city": "SAINT PETERSBURG",
            "state": "FL",
            "postal_code": "337014634",
            "telephone_number": "727-898-7451"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "4014 Leavenworth St",
            "address_purpose": "LOCATION",
            "city": "Omaha",
            "state": "NE",
            "postal_code": "681051053",
            "country_code": "US",
            "telephone_number": "402-559-5208",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1600 S 48th St",
            "address_purpose": "LOCATION",
            "city": "Lincoln",
            "state": "NE",
            "postal_code": "685061283",
            "country_code": "US",
            "telephone_number": "402-481-5791",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "35 Michigan St NE Ste 3003",
            "address_purpose": "LOCATION",
            "city": "Grand Rapids",
            "state": "MI",
            "postal_code": "495032528",
            "country_code": "US",
            "telephone_number": "616-267-2500",
            "fax_number": "616-267-2501",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "HERNANDEZ",
        "first_name": "ANGEL",
        "middle_name": "WILFREDO",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-10-02",
        "last_updated": "2024-01-10",
        "certification_date": "2024-01-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2084N0402X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Neurology with Special Qualifications in Child Neurology",
            "state": "MI",
            "license": "4301065634",
            "primary": false
        },
        {
            "code": "2084N0402X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Neurology with Special Qualifications in Child Neurology",
            "state": "NE",
            "license": "32763",
            "primary": false
        },
        {
            "code": "2084N0402X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Neurology with Special Qualifications in Child Neurology",
            "state": "FL",
            "license": "ME164141",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "direct@direct.bronsonhg.org",
            "affiliation": "Y",
            "endpointDescription": "Bronson Healthcare Group Direct address",
            "affiliationName": "Bronson Healthcare Group",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "Continuity of Care Document",
            "address_1": "601 John St",
            "city": "Kalamazoo",
            "state": "MI",
            "country_code": "US",
            "postal_code": "490075341",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "ahernandez143721@epic00.shdirect.org",
            "affiliation": "N",
            "address_1": "35 Michigan St NE Ste 3003",
            "city": "Grand Rapids",
            "state": "MI",
            "country_code": "US",
            "postal_code": "495032528",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "FHIR",
            "endpointTypeDescription": "FHIR URL",
            "endpoint": "https://epicarr02.spectrumhealth.org/EpicFHIR/api/FHIR/DSTU2/",
            "affiliation": "N",
            "address_1": "35 Michigan St NE Ste 3003",
            "city": "Grand Rapids",
            "state": "MI",
            "country_code": "US",
            "postal_code": "495032528",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "first_name": "ANGEL",
            "last_name": "HERNANDEZ",
            "middle_name": "WILFREDO",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in St Petersburg, FL

Sources for this page

Verify at the official NPI Registry.