Erica L Hertzog, PHN

Primary specialty

Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X

License

9957 Issued in MN

Practice address

1120 Wayzata Blvd E Ste 210
Wayzata, MN 55391-1915

Phone

(320) 864-1236

NPI assigned

Mar 23, 2018

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in MN

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Nurse Practitioner

Education

Other, 2022

Medicare assignment

May accept Medicare assignment

Telehealth

Offers telehealth services

Group practices

Portages Health LLCGroup PAC ID 6800269861, 3 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

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.

• Portages Health LLC

  • Prescribing (Medical) Psychologist
  • Minneapolis, MN
  • NPI 1942945761
  Medicare reassignment Care Compare group NPD
• McLeod County Public Health

  • Public Health or Welfare Agency
  • Glencoe, MN
  • NPI 1578550190
  NPD (past)

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

{
    "created_epoch": "1521763200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1678320000000",
    "number": "1942704895",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1120 WAYZATA BLVD E STE 210",
            "city": "WAYZATA",
            "state": "MN",
            "postal_code": "553911915",
            "telephone_number": "952-443-4600",
            "fax_number": "952-443-4604"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1120 WAYZATA BLVD E STE 210",
            "city": "WAYZATA",
            "state": "MN",
            "postal_code": "553911915",
            "telephone_number": "320-864-1236"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HERTZOG",
        "first_name": "ERICA",
        "middle_name": "L",
        "credential": "PHN",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2018-03-23",
        "last_updated": "2023-03-09",
        "certification_date": "2023-03-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "163WC1500X",
            "taxonomy_group": "",
            "desc": "Registered Nurse, Community Health",
            "state": "MN",
            "license": "R-186114-1",
            "primary": false
        },
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "MN",
            "license": "9957",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Healing Roots Counseling
• Healthtouch Home Care, Inc.
• Darlene Heimerl, M.A.
• Julia Ann Herman, D.D.S
• Lee Ann Hertzog Donovan, CPNP
• Jonathan Hess
• Hillcrest of Wayzatta Operations LLC
• Barbara Joanne Hilleren, MA, LP
• Harry Mark Hoberman, PH.D.
• Judith Marie Hock

• Psychiatric/Mental Health Nurse Practitioner in Wayzata, MN
• Providers in Wayzata, MN by specialty
• Psychiatric/Mental Health Nurse Practitioner in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 9, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.