NPIMap

Individual provider Active NPI

Deidra A Hertz, CFNP

  • Nurse Practitioner
  • Ocean Springs, MS
National Provider Identifier
1467565093
Registry record updated Nov 15, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nurse PractitionerTaxonomy code 363L00000X
License
R783864 Issued in MS
Practice address
4 Doctors Dr
Suite C
Ocean Springs, MS 39564
Phone
(228) 818-0053
Fax
(228) 818-0110
NPI assigned
Aug 17, 2006
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Nov 15, 2010

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Nurse Practitioner 363L00000X R783864 MS Primary

Addresses

Primary practice location

4 Doctors Dr
Suite C
Ocean Springs, MS 39564

Mailing address

4 Doctors Dr
Suite C
Ocean Springs, MS 39564
Phone (228) 818-0053

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MS
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
I20050105000955 MS Practitioner - Nurse Practitioner 0446208573 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2004
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Sun Coast Pain Management, P.a.Group PAC ID 7012810807, 3 clinicians

Practice addresses (Care Compare)

1720 A Medical Park Dr
Suite 310
Biloxi, MS 39532-2127
Phone (228) 818-0053

4 Doctors Dr
Suite C
Ocean Springs, MS 39564-5721
Phone (228) 818-0053

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
R783864MSMDNurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Sun Coast Pain Management, P.a. CurrentSince Sep 5, 2006 Accepting new patients

Locations

1720A Medical Park Dr
Ste 310
Biloxi, MS 39532
Phone (228) 396-0745

4 Doctors Dr
#C
Ocean Springs, MS 39564
Phone (228) 818-0053

Organizations & group practices 1

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 63

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

View all 63

NPI Registry JSON

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

{
    "created_epoch": "1155772800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1289779200000",
    "number": "1467565093",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4 DOCTORS DR",
            "address_2": "SUITE C",
            "city": "OCEAN SPRINGS",
            "state": "MS",
            "postal_code": "39564",
            "telephone_number": "228-818-0053",
            "fax_number": "228-818-0110"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4 DOCTORS DR",
            "address_2": "SUITE C",
            "city": "OCEAN SPRINGS",
            "state": "MS",
            "postal_code": "39564",
            "telephone_number": "228-818-0053",
            "fax_number": "228-818-0110"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HERTZ",
        "first_name": "DEIDRA",
        "middle_name": "A",
        "name_prefix": "Mrs.",
        "credential": "CFNP",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2006-08-17",
        "last_updated": "2010-11-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "MS",
            "license": "R783864",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Ocean Springs, MS

Sources for this page

Verify at the official NPI Registry.