NPIMap

Individual provider Active NPI

Judy E Herbolsheimer, PA-C

  • Physician Assistant
  • Tawas City, MI
National Provider Identifier
1861480600
Registry record updated Apr 6, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
Practice address
25 M 55 E
Tawas City, MI 48763-9362
Phone
(989) 362-8691
Fax
(989) 362-7290
NPI assigned
Oct 6, 2005
Last updated
Apr 6, 2021By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 6, 2021

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X Primary
Obstetrics & Gynecology Physician 207V00000X 5601004037 MI

Addresses

Primary practice location

25 M 55 E
Tawas City, MI 48763-9362

Mailing address

PO Box 779
Tawas City, MI 48764-0779
Phone (989) 362-2540

Other identifiers 1

IdentifierTypeStateIssuer
3043530MedicaidMI

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address judyherbolsheimer@smomsjhs.allscriptsdirect.net

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MI
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
I20040428000027 MI Practitioner - Physician Assistant 4880681246 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2003
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Mymichigan Medical Center TawasGroup PAC ID 9638070766, 36 clinicians

Practice addresses (Care Compare)

25 E M
55 Mymichigan Obstetrics and Gynecology
Tawas City, MI 48763-9362
Phone (989) 362-2540

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

State licenses

LicenseStateTypeSpecialty
5601004037MIMDObstetrics & Gynecology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Mymichigan Medical Center Tawas CurrentSince Dec 23, 2009 Accepting new patients
Mymichigan Medical Center Tawas Obstetrics & Gynecology Current Accepting new patients
Mymichigan Medical Center Tawas CurrentSince Dec 23, 2009 Accepting new patients
Mymichigan Medical Center Tawas Past Accepting new patients

Locations

302 S Main St
Au Gres, MI 48703
Phone (517) 876-7104

4000 Wellness Dr
Midland, MI 48670
Phone (844) 832-1956

200 Hemlock Rd
Tawas City, MI 48763
Phone (989) 362-3411

200 Hemlock St
Tawas City, MI 48763
Phone (989) 362-0153

25 E M 55
Tawas City, MI 48763
Phone (989) 362-2540

325 E M 55
Tawas City, MI 48763
Phone (989) 362-2754

Interoperability endpoints

  • Direct secure messaging: judy.herbolsheimer.1@11016.direct.athenahealth.com

Organizations & group practices 4

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 9

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": "1128556800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1617667200000",
    "number": "1861480600",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 779",
            "city": "TAWAS CITY",
            "state": "MI",
            "postal_code": "487640779",
            "telephone_number": "989-362-2540",
            "fax_number": "989-362-9925"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "25 M 55 E",
            "city": "TAWAS CITY",
            "state": "MI",
            "postal_code": "487639362",
            "telephone_number": "989-362-8691",
            "fax_number": "989-362-7290"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HERBOLSHEIMER",
        "first_name": "JUDY",
        "middle_name": "E",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2005-10-06",
        "last_updated": "2021-04-06",
        "certification_date": "2021-04-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "207V00000X",
            "taxonomy_group": "",
            "desc": "Obstetrics & Gynecology",
            "state": "MI",
            "license": "5601004037",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "3043530",
            "state": "MI"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "judyherbolsheimer@smomsjhs.allscriptsdirect.net",
            "affiliation": "N",
            "address_1": "25 M 55 E",
            "city": "Tawas City",
            "state": "MI",
            "country_code": "US",
            "postal_code": "487639362",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Tawas City, MI

Sources for this page

Verify at the official NPI Registry.