Active NPI
Paul F Hergenroeder, MD
- Hospice and Palliative Medicine (Internal Medicine) Physician
- Cleveland, OH
National Provider Identifier
1942206388
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Hospice and Palliative Medicine (Internal Medicine) Physician
- License
- 35.087486
- Practice address
- 17876 Saint Clair Ave
Cleveland, OH 44110 - Phone
- (216) 383-2222
- Fax
- (216) 298-0241
- NPI assigned
- Jun 21, 2005
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Hospice and Palliative Medicine (Internal Medicine) Physician | 207RH0002X | 35.087486 | OH | Primary |
| Hematology & Oncology Physician | 207RH0003X | 35.087486 | OH |
Addresses
Primary practice location
17876 Saint Clair Ave
Cleveland, OH 44110
Mailing address
17876 Saint Clair Ave
Cleveland, OH 44110-2602
Phone (216) 383-2222
Other practice location 1
2500 Metrohealth Dr
Cleveland, OH 44109-1900
Phone (216) 778-5802
Other identifiers 3
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 140052 | Other | PA | PA GROUP |
| 0159 | Other | PA | BLUE CROSS |
| 1010757980001 | Medicaid | PA |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1119312000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1561507200000",
"number": "1942206388",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "17876 SAINT CLAIR AVE",
"city": "CLEVELAND",
"state": "OH",
"postal_code": "441102602",
"telephone_number": "216-383-2222",
"fax_number": "216-298-0241"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "17876 SAINT CLAIR AVE",
"city": "CLEVELAND",
"state": "OH",
"postal_code": "44110",
"telephone_number": "216-383-2222",
"fax_number": "216-298-0241"
}
],
"practiceLocations": [
{
"address_1": "2500 Metrohealth Dr",
"address_purpose": "LOCATION",
"city": "Cleveland",
"state": "OH",
"postal_code": "441091900",
"country_code": "US",
"telephone_number": "216-778-5802",
"fax_number": "216-778-8300",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "HERGENROEDER",
"first_name": "PAUL",
"middle_name": "F",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2005-06-21",
"last_updated": "2019-06-26",
"status": "A"
},
"taxonomies": [
{
"code": "207RH0002X",
"taxonomy_group": "",
"desc": "Internal Medicine, Hospice and Palliative Medicine",
"state": "OH",
"license": "35.087486",
"primary": true
},
{
"code": "207RH0003X",
"taxonomy_group": "",
"desc": "Internal Medicine, Hematology & Oncology",
"state": "OH",
"license": "35.087486",
"primary": false
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "PA GROUP",
"identifier": "140052",
"state": "PA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BLUE CROSS",
"identifier": "0159",
"state": "PA"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "1010757980001",
"state": "PA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Cleveland, OH
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 26, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.