KELLI A HERTZ (M.D.) – Obstetrics & Gynecology Physician, NPI 1538199591
Obstetrics & Gynecology Physician
Main info
Doctor Profile
Profile Insights
NPPES metrics only — not quality of care.
966 OBSTETRICS/GYNECOLOGY in IN
Provider Addresses for KELLI A HERTZ (M.D.)
1205 HADLEY RD STE 120
MOORESVILLE, IN 461581934
Phone: (317) 834-8960
Fax: (317) 834-8951
Type: Location
1190 W Main St Ste 200
Vevay, IN 470433665
Phone: (812) 427-9564
Fax: (812) 427-9621
Type: Location
2051 Clevidence Blvd Ste B
Clarksville, IN 471292278
Phone: (502) 629-2030
Fax: (502) 629-2070
Type: Location
206 W Tyson St Ste 1A
Versailles, IN 470428036
Phone: (812) 689-5101
Fax: (812) 689-6199
Type: Location
1373 E State Road 62 Ste 2F
Madison, IN 472507328
Phone: (812) 801-0856
Fax: (812) 801-0771
Type: Location
PO BOX 776351
CHICAGO, IL 606776351
Phone: (502) 588-9490
Fax: (502) 272-5116
Type: Mailing
1373 E STATE ROAD 62 STE 2F
MADISON, IN 472507328
Phone: (812) 801-0856
Fax: (812) 801-0771
Type: Location
Evansville Post office, 402, Water Street, Evansville, Rock County, Wisconsin, 53536, United States
EVANSVILLE, IN 477323395
Phone:
Type: Mailing
East Clifty Drive, Madison, Jefferson County, Indiana, 47250, United States
MADISON, IN 47250
Phone: (812) 801-0856
Fax: (812) 801-0769
Type: Location
PO BOX 781076
DETROIT, MI 482781008
Phone: (317) 528-4800
Fax: (317) 865-1479
Type: Mailing
NPPES updates history
No NPPES updates recorded for this provider.
Prescription Activity
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Open Payments (CMS)
No Open Payments data available for this provider.
This can happen when there are no reportable CMS Open Payments records.
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: 2010-09-17
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 |
|---|---|---|---|---|
| I20100917001081 | I | Obstetrics/Gynecology | IN | 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.
Top Medicare procedures (2023) · refreshed 2026-05-27
| HCPCS | Description | Services | Beneficiaries | Medicare allowed |
|---|---|---|---|---|
| 77063 | Screening 3d breast mammography | 288 | 288 | $0 |
| 77067 | Screening mammography | 287 | 287 | $0 |
| 99213 | Established patient office or other outpatient visit, 20-29 minutes | 42 | 32 | $0 |
| 77080 | Dxa bone density measurement of hip, pelvis, spine | 32 | 32 | $0 |
| G0101 | Cervical or vaginal cancer screening; pelvic and clinical breast examination | 18 | 18 | $0 |
Insurance plans in this area (ZIP 46158)
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Group practice members
| Name | Specialty | State |
|---|---|---|
| Nurse Practitioner | IL | |
| Orthopedic Surgery | IN | |
| Nurse Practitioner | KY | |
| Nurse Practitioner | IL | |
| Family Practice | IL | |
| Nurse Practitioner | KY | |
| - | IL | |
| Internal Medicine | KY | |
| Nurse Practitioner | IL | |
| Nurse Practitioner | IL |
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