NPIMap

Individual provider Active NPI

Brian E Hertel, PA-C

  • Surgical Physician Assistant
  • Chandler, AZ
National Provider Identifier
1861491706
Registry record updated Aug 9, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Surgical Physician AssistantTaxonomy code 363AS0400X
License
3065 Issued in AZ
Practice address
4424 E Virgo PL
Chandler, AZ 85249-5898
Phone
(480) 229-7651
NPI assigned
Jul 21, 2005
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 9, 2019

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Surgical Physician Assistant 363AS0400X 3065 AZ Primary

Addresses

Primary practice location

4424 E Virgo PL
Chandler, AZ 85249-5898

Mailing address

4424 E Virgo PL
Chandler, AZ 85249-5898
Phone (480) 229-7651

Other identifiers 1

IdentifierTypeStateIssuer
886872MedicaidAZ

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in AZ
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
I20041101000607 AZ Practitioner - Physician Assistant 4981666062 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2004
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Banner Physician Specialists Arizona LLCGroup PAC ID 6204002272, 371 clinicians

Practice addresses (Care Compare)

10401 W Thunderbird Blvd
Sun City, AZ 85351-3004
Phone (623) 832-4000

1400 S Dobson Rd
Banner Health Clinic
Mesa, AZ 85202-4707
Phone (480) 412-3000

6424 E Broadway Rd
Suite 105
Mesa, AZ 85206-1750
Phone (480) 684-6487

9165 W Thunderbird Rd
Suite 200
Peoria, AZ 85381-4847
Phone (623) 285-1120

Hospital & facility affiliations

  • Banner Heart Hospital Hospital, Mesa, AZ, CCN 030105
  • Banner Desert Medical Center Hospital, Mesa, AZ, CCN 030065

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
3065AZMDPlastic Surgery Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Banner Physician Specialists Arizona LLC CurrentSince Jan 18, 2025 Accepting new patients
Banner Physician Specialists Arizona LLC CurrentSince Jan 18, 2025 Accepting new patients
Desert Cardiothoracic Surgeons, PLLC Past Accepting new patients

Locations

6644 E Baywood Ave
Mesa, AZ 85206
Phone (480) 321-2000

6750 E Baywood Ave
Ste 507
Mesa, AZ 85206
Phone (480) 409-5060

6424 E Broadway Rd
Ste 105
Mesa, AZ 85206
Phone (480) 248-3000

9165 W Thunderbird Rd
Ste 200
Peoria, AZ 85381
Phone (623) 285-1120

Organizations & group practices 13

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.

View all 13

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": "1121904000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1565308800000",
    "number": "1861491706",
    "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"
        },
        {
            "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"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HERTEL",
        "first_name": "BRIAN",
        "middle_name": "E",
        "name_prefix": "Mr.",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-07-21",
        "last_updated": "2019-08-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AS0400X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Surgical",
            "state": "AZ",
            "license": "3065",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "886872",
            "state": "AZ"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Chandler, AZ

Sources for this page

Verify at the official NPI Registry.