Individual provider Active NPI

Leah Nicole Herzog, M.D.

  • Surgery Physician
  • Charleston, SC
National Provider Identifier
1780066530
Registry record updated Jun 28, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Surgery PhysicianTaxonomy code 208600000X
License
38589 Issued in SC
Practice address
169 Ashley Ave
Room 202 Main Hospital, MSC 333
Charleston, SC 29425-8905
Phone
(843) 792-3072
NPI assigned
Jun 28, 2015
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jun 28, 2015

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Surgery Physician 208600000X 38589 SC Primary

Addresses

Primary practice location

169 Ashley Ave
Room 202 Main Hospital, MSC 333
Charleston, SC 29425-8905

Mailing address

169 Ashley Ave
Room 202 Main Hospital, MSC 333
Charleston, SC 29425-8905
Phone (843) 792-3072

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NV, VA2 enrollments
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20221213000486 NV Practitioner - Orthopedic Surgery 8628378965 Reassigns benefits to 1 organization
I20250106001745 VA Practitioner - Orthopedic Surgery 8628378965 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Orthopedic Surgery
Education
Drexel University College of Medicine, 2015
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Riverside Physician Services IncGroup PAC ID 5092608448, 793 clinicians

Practice addresses (Care Compare)

12200 Warwick Blvd
Suite 490
Newport News, VA 23601-2548
Phone (757) 534-6380

Hospital & facility affiliations

  • Riverside Regional Medical Center Hospital, Newport News, VA, CCN 490052
  • Riverside Doctors' Hospital of Williamsburg Hospital, Williamsburg, VA, CCN 490143

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
38589SCMDSurgery Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Vahey & Gluck Hand Surgery, LTD CurrentSince Sep 19, 2022 Accepting new patients
Riverside Physician Services Inc Current Accepting new patients
Riverside Physician Services, Inc. Surgery CurrentSince Oct 1, 2024 Accepting new patients
Riverside Physician Services Inc CurrentSince Oct 1, 2024 Accepting new patients
Riverside Physician Services Inc Past Accepting new patients

Locations

8585 S Eastern Ave
Ste 100
Las Vegas, NV 89123
Phone (702) 798-8585

858 J Clyde Morris Blvd
Newport News, VA 23601
Phone (757) 594-4343

856 J Clyde Morris Blvd
Ste A
Newport News, VA 23601
Phone (757) 316-5900

12200 Warwick Blvd
Ste 490
Newport News, VA 23601
Phone (757) 534-5600

Interoperability endpoints

  • Direct secure messaging: lherzog236222@direct.rivhs.com

Organizations & group practices 5

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 2

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": "1435449600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1435449600000",
    "number": "1780066530",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "169 ASHLEY AVE",
            "address_2": "ROOM 202 MAIN HOSPITAL, MSC 333",
            "city": "CHARLESTON",
            "state": "SC",
            "postal_code": "294258905",
            "telephone_number": "843-792-3072"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "169 ASHLEY AVE",
            "address_2": "ROOM 202 MAIN HOSPITAL, MSC 333",
            "city": "CHARLESTON",
            "state": "SC",
            "postal_code": "294258905",
            "telephone_number": "843-792-3072"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HERZOG",
        "first_name": "LEAH",
        "middle_name": "NICOLE",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2015-06-28",
        "last_updated": "2015-06-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208600000X",
            "taxonomy_group": "",
            "desc": "Surgery",
            "state": "SC",
            "license": "38589",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Charleston, SC

Sources for this page

Verify at the official NPI Registry.