Active NPI
Greg Lauritz Ichtertz, M.D.
- Hospitalist Physician
- Hattiesburg, MS
National Provider Identifier
1598884454
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Hospitalist Physician
- License
- 19698
- Practice address
- 415 S 28TH Ave
Hattiesburg, MS 39401-7246 - Phone
- (601) 288-4329
- Fax
- (601) 288-3191
- NPI assigned
- Mar 29, 2007
- Last updated
- Jan 30, 2015
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Hospitalist Physician | 208M00000X | 19698 | MS | Primary |
Addresses
Primary practice location
415 S 28TH Ave
Hattiesburg, MS 39401-7246
Mailing address
415 S 28TH Ave
Hattiesburg, MS 39401-7246
Phone (601) 579-5463
Other identifiers 3
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 04936743 | Medicaid | MS | |
| P00420680 | Other | MS | RAILROAD MEDICARE |
| 4045721 | Other | MS | AETNA |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Faith Regional Physician Services, LLC | Past | Accepting new patients | |
| Faith Regional Physician Services, LLC | Past | Accepting new patients |
Organizations & group practices 2
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.
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NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1175126400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1422576000000",
"number": "1598884454",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "415 S 28TH AVE",
"city": "HATTIESBURG",
"state": "MS",
"postal_code": "394017246",
"telephone_number": "601-579-5463",
"fax_number": "601-579-5240"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "415 S 28TH AVE",
"city": "HATTIESBURG",
"state": "MS",
"postal_code": "394017246",
"telephone_number": "601-288-4329",
"fax_number": "601-288-3191"
}
],
"practiceLocations": [],
"basic": {
"last_name": "ICHTERTZ",
"first_name": "GREG",
"middle_name": "LAURITZ",
"credential": "M.D.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2007-03-29",
"last_updated": "2015-01-30",
"status": "A"
},
"taxonomies": [
{
"code": "208M00000X",
"taxonomy_group": "",
"desc": "Hospitalist",
"state": "MS",
"license": "19698",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "04936743",
"state": "MS"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "RAILROAD MEDICARE",
"identifier": "P00420680",
"state": "MS"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "AETNA",
"identifier": "4045721",
"state": "MS"
}
],
"endpoints": [],
"other_names": []
}Other providers in Hattiesburg, MS
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 30, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.