NPIMap

Individual provider Active NPI

Mary A Herzog, MD

  • Orthopaedic Surgery Physician
  • Grand Rapids, MI
National Provider Identifier
1750543674
Registry record updated Jul 1, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Orthopaedic Surgery PhysicianTaxonomy code 207X00000X
License
4301093037 Issued in MI
Practice address
300 Lafayette Ave SE # 3400
Grand Rapids, MI 49503-4600
Phone
(616) 752-6615
NPI assigned
Jul 1, 2008
Last updated
Jul 1, 2008By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 1, 2008

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Orthopaedic Surgery Physician 207X00000X 4301093037 MI Primary

Addresses

Primary practice location

300 Lafayette Ave SE # 3400
Grand Rapids, MI 49503-4600

Mailing address

300 Lafayette Ave SE # 3400
Grand Rapids, MI 49503-4600

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA
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
I20130508000137 CA Practitioner - Orthopedic Surgery 9234376476 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Orthopedic Surgery
Education
Other, 2008
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Enloe Medical CenterGroup PAC ID 9739092388, 330 clinicians

Practice addresses (Care Compare)

1600 Esplanade
Suite C
Chico, CA 95926-3369
Phone (530) 332-4470

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
81.49 of 100Reported as group
Quality
60.52
Promoting interoperability
100
Improvement activities
40
Cost
68.7

Procedures performed for Medicare patients

ProcedureNumber of procedures
Hip replacement1-10
Lower limb (leg) arthroscopy (minimally invasive joint repair)1-10
Removal of tissue19

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
4301093037MIMDOrthopaedic Surgery Physician

Practice roles

OrganizationSpecialtyStatusNew patients
University of California SFGH Medical Group CurrentSince Jun 15, 2013 Accepting new patients
University of California SFGH Medical Group Orthopaedic Surgery CurrentSince Jun 15, 2013 Accepting new patients
Enloe Medical Center Orthopaedic Surgery CurrentSince Jul 10, 2014 Accepting new patients
Enloe Medical Center CurrentSince Jul 10, 2014 Accepting new patients
Enloe Medical Center Past Accepting new patients
Enloe Medical Center Past Accepting new patients

Locations

1600 Esplanade
Ste C
Chico, CA 95926
Phone (530) 332-4470

1001 Potrero Ave
Bldg 53RD
San Francisco, CA 94110
Phone (628) 206-8265

Interoperability endpoints

  • Direct secure messaging: mherzog15265@enloedirect.org

Organizations & group practices 6

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.

Hospital & facility affiliations 3

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

NPI Registry JSON

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

{
    "created_epoch": "1214870400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1214870400000",
    "number": "1750543674",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "300 LAFAYETTE AVE SE # 3400",
            "city": "GRAND RAPIDS",
            "state": "MI",
            "postal_code": "495034600"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "300 LAFAYETTE AVE SE # 3400",
            "city": "GRAND RAPIDS",
            "state": "MI",
            "postal_code": "495034600",
            "telephone_number": "616-752-6615"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HERZOG",
        "first_name": "MARY",
        "middle_name": "A",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2008-07-01",
        "last_updated": "2008-07-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207X00000X",
            "taxonomy_group": "",
            "desc": "Orthopaedic Surgery",
            "state": "MI",
            "license": "4301093037",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Grand Rapids, MI

Sources for this page

Verify at the official NPI Registry.