KRISTINE C HERTZOG (PA) – Medical Physician Assistant, NPI 1750546040
Medical Physician Assistant
Main info
Doctor Profile
Profile Insights
NPPES metrics only — not quality of care.
9,231 PHYSICIAN ASSISTANT in FL
Provider Addresses for KRISTINE C HERTZOG (PA)
4227 FITZROY REEF DR
MIMS, FL 327542218
Phone: (407) 408-4355
Type: Mailing
10866 SHELDON RD
TAMPA, FL 336265117
Phone: (407) 718-8205
Type: Location
7725 MILLBROOK AVE
MELBOURNE, FL 329407812
Phone: (407) 408-4355
Type: Mailing
805 CENTURY MEDICAL DR STE A
TITUSVILLE, FL 327962100
Phone: (321) 567-7530
Fax: (321) 225-8723
Type: Location
NPPES updates history
No NPPES updates recorded for this provider.
Prescription Activity
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Open Payments (CMS)
CMS reports 13 Open Payments records for all available years, with a total value of $1,080.
Total Amount is formed as General ($1,080) + Research ($0) + Ownership ($0) = $1,080.
Last reported payment date: 2024-12-06 • Largest payer in this snapshot: E.R. Squibb & Sons, L.L.C. ($488).
Total Amount
$1,080
General + Research + Ownership
Payments
13
Total payment records
General Amount
$1,080
General payments
Research Amount
$0
Research funding
Ownership Amount
$0
Ownership interests
Ownership Count
0
Ownership records
Last Payment Date
2024-12-06
Latest reported date
Top Companies
Largest payers in this snapshot
Medicare Enrollment & Revalidation
Source: CMS public data · Not endorsed by CMS ·
Educational use only—not medical, billing, or legal advice.
PECOS enrollment status
Participating (accepts Medicare assignment)
Enrollment effective: 2009-03-27
PECOS data refreshed: 2026-05-27
Medicare revalidation (CMS due date list)
Due date not assigned yet
CMS is tracking this Medicare enrollment for revalidation, but has not published a due date.
Enrollment records
1
Earliest due date
Not assigned (TBD)
CMS data updated
2026-06-01
Revalidation progress
- Medicare enrolled
- On CMS revalidation list
- Due date assigned
- Revalidate in PECOS
CMS enrollment records
| Enrollment ID | Type | Specialty | State | Due date |
|---|---|---|---|---|
| I20090327000426 | I | Physician Assistant | FL | TBD |
What to do next
- No action required while the due date shows TBD.
- Check the CMS Revalidation Lookup Tool periodically — CMS updates the list about every 60 days.
- Do not submit a revalidation application in PECOS until CMS publishes a concrete due date.
Prepare CMS-855 application → · Look up this NPI in PECOS → · Verify on CMS PECOS
Medicare Utilization (FFS)
Source: CMS public data · Not endorsed by CMS · Beneficiary counts under 11 are suppressed in source data ·
Educational use only—not medical, billing, or legal advice.
No Medicare fee-for-service utilization data available for this provider in our database.
Insurance plans in this area (ZIP 32754)
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Provider's Procedures
| Specialty | Practice State | HCPCS Code | Description | Service Count | Beneficiary Count |
|---|---|---|---|---|---|
| PHYSICIAN ASSISTANT | FL | 17003 | Destruction of 2-14 skin growths | 1513 | 246 |
Group practice members
| Name | Specialty | State |
|---|---|---|
| Physician Assistant | VA | |
| Nurse Practitioner | FL | |
| Physician Assistant | FL | |
| D E R M A T O L O G Y | FL | |
| Physician Assistant | FL | |
| Physician Assistant | FL | |
| Physician Assistant | FL | |
| D E R M A T O L O G Y | FL | |
| - | FL |
Reviews
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