Gwen Herzog, RN

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

7630-33 Issued in WI

Practice address

903 Harvey Ave
Watertown, WI 53094-5007

Phone

(920) 248-1723

NPI assigned

Jun 2, 2015

Last updated

Apr 13, 2017By the provider in NPPES

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in WI, MN, OK, KY, NE5 enrollments

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 5

Specialty

Nurse Practitioner

Education

Other, 2016

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Oak Medical SCGroup PAC ID 0042595175, 118 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Aveanna Home Health Home health agency, Brookfield, WI, CCN 527273
• Vitas Healthcare Corp Midwest Hospice, Milwaukee, WI, CCN 521553
• Agrace Hospicecare Hospice, Madison, WI, CCN 521505
• Holy Family Memorial Hospital, Manitowoc, WI, CCN 520107
• Fort Memorial Hospital Hospital, Fort Atkinson, WI, CCN 520071
• Waukesha Memorial Hospital Hospital, Waukesha, WI, CCN 520008

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner, Registered Nurse

State licenses

Practice roles

Locations

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.

• Oak Medical SC

  • Internal Medicine Physician
  • Waukesha, WI
  • NPI 1669910345
  Medicare reassignment Care Compare group NPD
• Agrace Palliative Care LLC

  • Hospice and Palliative Medicine (Internal Medicine) Physician
  • Fitchburg, WI
  • NPI 1326386129
  Medicare reassignment NPD
• Maple Medical SC

  • Physical Medicine & Rehabilitation Physician
  • Waukesha, WI
  • NPI 1487152104
  Medicare reassignment NPD
• Villagehealth DM LLC

  • Case Management Agency
  • Denver, CO
  • NPI 1598273211

  KY, MN, NE, OK, WI

  Medicare reassignment

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

• Agrace Hospicecare, Incorporated

  • Community Based Hospice Care Agency
  • Fitchburg, WI
  • NPI 1861503534
  Care Compare affiliation
• Fort Healthcare Inc

  • Otolaryngology Physician
  • Fort Atkinson, WI
  • NPI 1417993361

  Hospital

  Care Compare affiliation
• Fort Healthcare, Inc.

  • General Acute Care Hospital
  • Fort Atkinson, WI
  • NPI 1811916281
  Care Compare affiliation
• Holy Family Memorial Inc

  dba Froedtert Holy Family Memorial Hospital

  • General Acute Care Hospital
  • Manitowoc, WI
  • NPI 1700998697
  Care Compare affiliation
• Prohealth Waukesha Memorial Hospital, Inc.

  • General Acute Care Hospital
  • Waukesha, WI
  • NPI 1629056890
  Care Compare affiliation
• Recover Health of Wisconsin, Inc.

  dba Aveanna Home Health

  • Home Health Agency
  • Brookfield, WI
  • NPI 1710967104
  Care Compare affiliation
• Vitas Healthcare Corporation Midwest

  • Community Based Hospice Care Agency
  • Milwaukee, WI
  • NPI 1538201108
  Care Compare affiliation

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

{
    "created_epoch": "1433203200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1492041600000",
    "number": "1467832667",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "903 HARVEY AVE",
            "city": "WATERTOWN",
            "state": "WI",
            "postal_code": "530945007"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "903 HARVEY AVE",
            "city": "WATERTOWN",
            "state": "WI",
            "postal_code": "530945007",
            "telephone_number": "920-248-1723"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HERZOG",
        "first_name": "GWEN",
        "credential": "RN",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2015-06-02",
        "last_updated": "2017-04-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "WI",
            "license": "7630-33",
            "primary": true
        },
        {
            "code": "163W00000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse",
            "state": "WI",
            "license": "191155",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Robert Delano Heinen, MD
• Amber Rose Hendriksen, NP
• Heritage Assisted Living of Watertown, LLC (Heritage Homes Assisted Living)
• Shandell Lee Herrick, FNP-BC
• Desiree Monik Herron, O.D.
• Catherine Hetzel
• Angela Hill, OTR
• Nicholas Earl Hoening, PT
• Richard C Holden, M.D.
• Edward J Hoy, MD

• Family Nurse Practitioner in Watertown, WI
• Providers in Watertown, WI by specialty
• Family Nurse Practitioner in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 13, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.