Individual provider Active NPI

Michael Erik Hernandez, DO

  • Family Medicine Physician
  • Garden Grove, CA
National Provider Identifier
1790282903
Registry record updated Nov 3, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
20A18072 Issued in CA
Practice address
12942 Harbor Blvd
Garden Grove, CA 92840-5809
Phone
(714) 705-2120
NPI assigned
Apr 12, 2018
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 3, 2021

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 20A18072 CA Primary

Addresses

Primary practice location

12942 Harbor Blvd
Garden Grove, CA 92840-5809

Mailing address

12942 Harbor Blvd
Garden Grove, CA 92840-5809
Phone (714) 705-2120

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address mhernandez1751028@oc.providencedirect.org

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA
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 1

Enrollment IDStateProvider typePAC IDDetails
I20210727003149 CA Practitioner - Family Practice 2961805056 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Other, 2018
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Providence Medical FoundationGroup PAC ID 8921993205, 1,461 clinicians

Practice addresses (Care Compare)

12942 Harbor Blvd
Garden Grove, CA 92840-5809
Phone (714) 705-2120

134000 Jamboree Rd
Irvine, CA 92602-2308
Phone (714) 263-9279

1950 Sunny Crest Dr
Suite 2900
Fullerton, CA 92835-3641
Phone (714) 992-5350

2212 E 4TH St
Santa Ana, CA 92705-3870
Phone (714) 633-1011

2501 E Chapman Ave
Orange, CA 92869-3204
Phone (714) 633-7175

Hospital & facility affiliations

  • Providence at Home With Compassus Home Health, Orange County South Home health agency, Irvine, CA, CCN 058238
  • Providence St. Joseph Hospital Hospital, Orange, CA, CCN 050069

Procedures performed for Medicare patients

ProcedureNumber of procedures
Removal of skin lesions1-10
Removal or shaving of skin growth1-10
Skin biopsy1-10

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
20A18072CAMDFamily Medicine Physician
18072CAMDOccupational Therapist

Practice roles

OrganizationSpecialtyStatusNew patients
Providence Medical Foundation Current Accepting new patients
Providence Medical Foundation Family Medicine CurrentSince Jul 12, 2021 Accepting new patients
Providence Medical Foundation Family Medicine CurrentSince Jul 12, 2021 Accepting new patients
St. Joseph Health Northern California, LLC Past Accepting new patients
Providence Medical Foundation Family Medicine Past Accepting new patients

Locations

5630 E Santa Ana Canyon Rd
Ste 100
Anaheim, CA 92807
Phone (714) 257-6170

2251 N Harbor Blvd
Fullerton, CA 92835
Phone (714) 449-6230

1950 Sunny Crest Dr
Ste 2900
Fullerton, CA 92835

100 E Valencia Mesa Dr
Ste 105
Fullerton, CA 92835
Phone (714) 446-5200

12942 Harbor Blvd
Garden Grove, CA 92840
Phone (714) 618-9540

2501 E Chapman Ave
Ste 101
Orange, CA 92869
Phone (714) 628-3300

Networks

  • BSC 65 PLUS INDIVIDUAL MAPD

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 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": "1523491200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1635897600000",
    "number": "1790282903",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12942 HARBOR BLVD",
            "city": "GARDEN GROVE",
            "state": "CA",
            "postal_code": "928405809",
            "telephone_number": "714-705-2120"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12942 HARBOR BLVD",
            "city": "GARDEN GROVE",
            "state": "CA",
            "postal_code": "928405809",
            "telephone_number": "714-705-2120"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HERNANDEZ",
        "first_name": "MICHAEL",
        "middle_name": "ERIK",
        "credential": "DO",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2018-04-12",
        "last_updated": "2021-11-03",
        "certification_date": "2021-11-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "CA",
            "license": "20A18072",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "mhernandez1751028@oc.providencedirect.org",
            "affiliation": "N",
            "address_1": "12942 Harbor Blvd",
            "city": "Garden Grove",
            "state": "CA",
            "country_code": "US",
            "postal_code": "928405809",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Garden Grove, CA

Sources for this page

Verify at the official NPI Registry.