Active NPI
Anna Ross Hertel, PSY.D.
- Clinical Psychologist
- Fayetteville, AR
National Provider Identifier
1972697415
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Psychologist
- License
- 2003023851
- Practice address
- 1100 N College Ave
Fayetteville, AR 72703-1944 - Phone
- (800) 691-8387
- NPI assigned
- Oct 2, 2006
- Sex
- Female
- Sole proprietor
- Yes
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 |
|---|---|---|---|---|
| Psychologist | 103T00000X | 2003023851 | MO | |
| Clinical Psychologist | 103TC0700X | 2003023851 | MO | Primary |
Addresses
Primary practice location
1100 N College Ave
Fayetteville, AR 72703-1944
Mailing address
PO Box 2429
Smyrna, TN 37167-1719
Phone (417) 891-4800
Other practice location 1
600 N Main St
Mount Vernon, MO 65712-1004
Phone (417) 466-0198
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 498311117 | Medicaid | MO |
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
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Eustasis Foundation, Inc | Current | Accepting new patients |
Locations
3100 S National Ave
Ste 103
Springfield, MO 65807
Phone (417) 322-6622
Organizations & group practices 1
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.
-
- Voluntary or Charitable Agency
- Springfield, MO
- NPI 1386257780
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1159747200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1588636800000",
"number": "1972697415",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 2429",
"city": "SMYRNA",
"state": "TN",
"postal_code": "371671719",
"telephone_number": "417-891-4800"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1100 N COLLEGE AVE",
"city": "FAYETTEVILLE",
"state": "AR",
"postal_code": "727031944",
"telephone_number": "800-691-8387"
}
],
"practiceLocations": [
{
"address_1": "600 N Main St",
"address_purpose": "LOCATION",
"city": "Mount Vernon",
"state": "MO",
"postal_code": "657121004",
"country_code": "US",
"telephone_number": "417-466-0198",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "HERTEL",
"first_name": "ANNA",
"middle_name": "ROSS",
"name_prefix": "Dr.",
"credential": "PSY.D.",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2006-10-02",
"last_updated": "2020-05-05",
"certification_date": "2020-05-05",
"status": "A"
},
"taxonomies": [
{
"code": "103T00000X",
"taxonomy_group": "",
"desc": "Psychologist",
"state": "MO",
"license": "2003023851",
"primary": false
},
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "MO",
"license": "2003023851",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "498311117",
"state": "MO"
}
],
"endpoints": [],
"other_names": []
}Other providers in Fayetteville, AR
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 5, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.