Brian Hertel Pac LLC

Primary specialty

Surgical Physician AssistantTaxonomy code 363AS0400X

License

3065 Issued in AZ

Legal business name

BRIAN HERTEL PAC LLC

Practice address

4424 E Virgo PL
Chandler, AZ 85249-5898

Phone

(480) 229-7651

Fax

(480) 596-8522

NPI assigned

Oct 28, 2006

Last updated

Aug 9, 2019By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Brian E. Hertel, PACNPI 1861491706

Title

Phycisian Assistant

Phone

(480) 229-7651

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in AZ

Enrollment records 1

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Brian E Hertel, PA-C

  • Surgical Physician Assistant
  • Chandler, AZ
  • NPI 1861491706
  Medicare reassignment Authorized official

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

{
    "created_epoch": "1161993600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1565308800000",
    "number": "1841376126",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4424 E VIRGO PL",
            "city": "CHANDLER",
            "state": "AZ",
            "postal_code": "852495898",
            "telephone_number": "480-229-7651",
            "fax_number": "480-596-8522"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4424 E VIRGO PL",
            "city": "CHANDLER",
            "state": "AZ",
            "postal_code": "852495898",
            "telephone_number": "480-229-7651",
            "fax_number": "480-596-8522"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BRIAN HERTEL PAC LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-10-28",
        "last_updated": "2019-08-09",
        "status": "A",
        "authorized_official_last_name": "HERTEL",
        "authorized_official_first_name": "BRIAN",
        "authorized_official_middle_name": "E.",
        "authorized_official_title_or_position": "PHYCISIAN ASSISTANT",
        "authorized_official_telephone_number": "480-229-7651",
        "authorized_official_credential": "PAC"
    },
    "taxonomies": [
        {
            "code": "363AS0400X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Surgical",
            "state": "AZ",
            "license": "3065",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Surgical Physician Assistant in Chandler, AZ
• Providers in Chandler, AZ by specialty
• Surgical Physician Assistant in Arizona

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 9, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.