Edmond Mertzenich, DPM

Primary specialty

PodiatristTaxonomy code 213E00000X

License

016003825 Issued in IL

Practice address

1200 W State St
Rockford, IL 61102-2112

Phone

(815) 490-1600

Fax

(815) 490-1485

NPI assigned

Nov 23, 2005

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Dr. Edmond Mertzenich Professional name

Medicare fee-for-service enrollment

Enrolled in IL

Eligible to order & refer

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

Green means eligible to order or refer.

Enrollment records 1

Specialty

Podiatry

Education

William M. Scholl College of Podiatric Medicine, 1985

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Crusaders Central Clinic AssociationGroup PAC ID 5799682993, shared by 7 NPIs, 31 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Practice roles

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.

• Crusaders Central Clinic Association

  dba Crusader Clinic

  • Federally Qualified Health Center (FQHC)
  • Rockford, IL
  • NPI 1902972557
  NPD (past)

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

{
    "created_epoch": "1132704000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1343606400000",
    "number": "1558344598",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1200 W. STATE ST",
            "address_2": "CRUSADER COMMUNITY HEALTH",
            "city": "ROCKFORD",
            "state": "IL",
            "postal_code": "611022112",
            "telephone_number": "815-490-1600",
            "fax_number": "815-490-1485"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1200 W STATE ST",
            "city": "ROCKFORD",
            "state": "IL",
            "postal_code": "611022112",
            "telephone_number": "815-490-1600",
            "fax_number": "815-490-1485"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MERTZENICH",
        "first_name": "EDMOND",
        "name_prefix": "Dr.",
        "credential": "DPM",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-11-23",
        "last_updated": "2012-07-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "213E00000X",
            "taxonomy_group": "",
            "desc": "Podiatrist",
            "state": "IL",
            "license": "016003825",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "016003825",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "EDMOND",
            "last_name": "MERTZENICH",
            "prefix": "DR.",
            "credential": "DPM",
            "code": "2",
            "type": "Professional Name"
        }
    ]
}

• Mercy Ambulance Service LLC
• Mercy Assisted Care, Inc (Mercyhealth at Home)
• Mercyhealth Visiting Nurses Association, Inc (Mercyhealth at Home)
• Mercyhealth Visiting Nurses Association, Inc (Mercyhealth at Home)
• Hope Merkley, APRN, CNP
• Lara Renee Meschewski, MS, RD, LDN
• Tasha Messer, D.C.
• Amanda Messinger, LPC
• Lindsay M Metcalf, MS, ATC
• Jessica Metz, LMT

• Podiatrist in Rockford, IL
• Providers in Rockford, IL by specialty
• Podiatrist in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 30, 2012; 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.