MR. ROBERT HERZOG (PA) – Physician Assistant, NPI 1902963614
Physician Assistant
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Profile Insights
NPPES metrics only — not quality of care.
5,035 PHYSICIAN ASSISTANT in IL
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Provider Addresses for MR. ROBERT HERZOG (PA)
Carbondale Post Office, Main Street, Carbondale, Osage County, Kansas, 66414, United States
CARBONDALE, IL 629023988
Phone: (618) 457-5200
Type: Mailing
2601, West Main Street, Carbondale, Jackson County, Illinois, 62901, United States
CARBONDALE, IL 629011031
Phone: (618) 549-5361
Fax: (618) 351-4878
Type: Location
905 N Washington Street
Du Quoin, IL 628326283
Phone: (618) 542-1050
Type: Location
502 W Saint Louis St Ste 4
West Frankfort, IL 628961968
Phone: (618) 937-3400
Fax: (618) 997-9324
Type: Location
405 Rushing Dr
Herrin, IL 629483730
Phone: (618) 993-3000
Fax: (618) 993-0262
Type: Location
900 N Washington St
Du Quoin, IL 628321233
Phone: (618) 542-1050
Type: Location
NPPES updates history
No NPPES updates recorded for this provider.
Prescription Activity
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Open Payments (CMS)
CMS reports 16 Open Payments records for all available years, with a total value of $284.
Total Amount is formed as General ($284) + Research ($0) + Ownership ($0) = $284.
Last reported payment date: 2024-11-13 • Largest payer in this snapshot: Novo Nordisk Inc ($59).
Total Amount
$284
General + Research + Ownership
Payments
16
Total payment records
General Amount
$284
General payments
Research Amount
$0
Research funding
Ownership Amount
$0
Ownership interests
Ownership Count
0
Ownership records
Last Payment Date
2024-11-13
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: 2004-03-29
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 |
|---|---|---|---|---|
| I20040329000648 | I | Physician Assistant | IL | 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 62902)
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Group practice members
| Name | Specialty | State |
|---|---|---|
| Nurse Practitioner | IL | |
| Physician Assistant | IN | |
| Registered Dietitian Or Nutrition Professional | IL | |
| Nurse Practitioner | IL | |
| Critical Care (Intensivists), Internal Medicine | LA | |
| Nurse Practitioner | IL | |
| Internal Medicine | IL | |
| General Surgery | CA | |
| Certified Registered Nurse Anesthetist (Crna) | IL | |
| Nurse Practitioner | IL |
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