Robert Bruce Herzog (NPI# 1902963614, PAC ID# 6507758067) is a physician enrolled in Centers for Medicare & Medicaid Services (CMS). The primary specialty is PHYSICIAN ASSISTANT.
| Nation Provider ID (NPI) | 1902963614 |
| PAC ID by PECOS | 6507758067 |
| Professional Enrollment ID | I20040329000648 |
| Full Name | Robert Bruce Herzog |
| Organization Legal Name | SOUTHERN ILLINOIS MEDICAL SERVICES, NFP |
| Address |
2601 W Main St Carbondale IL 62901-1031 |
| Phone Number | 6185495361 |
| Gender | M |
| Credential | PA |
| Graduation Year | 2003 |
| Primary Specialty | PHYSICIAN ASSISTANT |
| Group Practice PAC ID | 3678677390 |
| Number of Group Practice Members | 325 |
| Accepts Medicare Assignment | Y |
| Claim Control Number (CCN) | Legal Business Name |
|---|---|
| 141334 | ST JOSEPH MEMORIAL HOSPITAL |
| Address | Phone | Organization |
|---|---|---|
| 2601 W Main St, Carbondale, IL 62901-1031 | 6185495361 | SOUTHERN ILLINOIS MEDICAL SERVICES, NFP |
| Organization Legal Name | SOUTHERN ILLINOIS MEDICAL SERVICES, NFP |
| Physicians | 338 |
| Name | Specialty | Organization | Address |
|---|---|---|---|
| Ellie Marie Bentley | General Surgery | Southern Illinois Medical Services, Nfp | 220 S Park Ave, Suite 3, Herrin, IL 62948-3612 |
| Victor Cepeda | Infectious Disease | Southern Illinois Medical Services, Nfp | 3314 Patriot Ct, Herrin, IL 62948-3782 |
| Arsalan Salamat | General Surgery | Southern Illinois Medical Services, Nfp | 1237 E Main St, C1, Carbondale, IL 62901-3148 |
| Motaz R Wraikat | Undersea and Hyperbaric Medicine | Southern Illinois Medical Services, Nfp | 315 S 14th St, Suite 3, Herrin, IL 62948-3601 |
| Mohammed Lawan Gana Guba | Hospitalist | Southern Illinois Medical Services, Nfp | 201 S 14th St, Herrin, IL 62948-3631 |
| Kowsika Movva | Family Medicine | Southern Illinois Medical Services, Nfp | 207 W Jackson St, Suite 102, Carbondale, IL 62901-1408 |
| Hammad Shafqat | Hematology/oncology | Southern Illinois Medical Services, Nfp | 1400 Pin Oak Dr, Carterville, IL 62918-1600 |
| Whitney Celeste Mcguire | Nurse Practitioner | Southern Illinois Medical Services, Nfp | 405 Rushing Dr, Herrin, IL 62948-3730 |
| Jason Liang | Podiatry | Southern Illinois Medical Services, Nfp | 19 E Shawnee Dr, Suite 2, Murphysboro, IL 62966-7072 |
| Saad Ajmal | General Surgery | Southern Illinois Medical Services, Nfp | 317 S 14th St, Suite 1, Herrin, IL 62948-3673 |
| Street Address |
2601 W MAIN ST |
| City | CARBONDALE |
| State | IL |
| Zip | 62901-1031 |
| Name | Specialty | Organization | Address |
|---|---|---|---|
| Muhammad J Popalzai | Hematology/oncology | Southern Illinois Medical Services, Nfp | 2601 W Main St, Carbondale, IL 62901-1031 |
| Melissa Andrea Martinez Mateo | Gastroenterology | Southern Illinois Medical Services, Nfp | 2601 W Main St, Carbondale, IL 62901-1031 |
| Lukas John Ward | Physician Assistant | Southern Illinois Medical Services, Nfp | 2601 W Main St, Carbondale, IL 62901-1031 |
| Emily D Hanson | Family Medicine | Southern Illinois Medical Services, Nfp | 2601 W Main St, Carbondale, IL 62901-1031 |
| Phillip A Dewey | Physician Assistant | Southern Illinois Medical Services, Nfp | 2601 W Main St, Carbondale, IL 62901-1031 |
| Jessie Nicole Fox | Nurse Practitioner | Southern Illinois Medical Services, Nfp | 2601 W Main St, Carbondale, IL 62901-1031 |
| Antoinette Marie Miller | Nurse Practitioner | Southern Illinois Medical Services, Nfp | 2601 W Main St, Carbondale, IL 62901-1031 |
| Nathaniel E Clark | Physician Assistant | Southern Illinois Medical Services, Nfp | 2601 W Main St, Carbondale, IL 62901-1031 |
| Srinivas Rajamahanty | Urology | Southern Illinois Medical Services, Nfp | 2601 W Main St, Carbondale, IL 62901-1031 |
| Anne E Fairfield | Physician Assistant | Southern Illinois Medical Services, Nfp | 2601 W Main St, Carbondale, IL 62901-1031 |
| Find all physicians in the same address | |||
| Name | Specialty | Organization | Address |
|---|---|---|---|
| Amy Nichole Dinga | Nurse Practitioner | Southern Illinois Medical Services, Nfp | 1400 Financial Park Dr, Carbondale, IL 62901 |
| Carlos Mario Rivera Serrano | Plastic and Reconstructive Surgery | Southern Illinois Medical Services, Nfp | 1400 Financial Park Dr, Carbondale, IL 62901 |
| Kelli Nicole Webb | Plastic and Reconstructive Surgery | Southern Illinois Medical Services, Nfp | 1400 Financial Park Dr, Carbondale, IL 62901 |
| Fakhre Alam | Neurology | 2731 W Main St, Suite A, Carbondale, IL 62901-1028 | |
| Kurt R Martin | Internal Medicine | Southern Illinois Medical Services, Nfp | 2601 W Main St, Carbondale, IL 62901-1031 |
| Leslie Ann Hickman | Nurse Practitioner | Southern Illinois Medical Services, Nfp | 2601 W Main St, Carbondale, IL 62901-1031 |
| Jessica Morgan Hays | Nurse Practitioner | Southern Illinois Medical Services, Nfp | 2601 W Main St, Carbondale, IL 62901-1031 |
| Jessica Oakley | Nurse Practitioner | Southern Illinois Medical Services, Nfp | 2601 W Main St, Carbondale, IL 62901-1031 |
| Sahithi Jarugula | Rheumatology | Southern Illinois Medical Services, Nfp | 2601 W Main St, Carbondale, IL 62901-1031 |
| Alicia K Cremeens | Physician Assistant | Southern Illinois Medical Services, Nfp | 2601 W Main St, Carbondale, IL 62901-1031 |
| Find all physicians in zip 62901 | |||
| City | CARBONDALE |
| Zip Code | 62901 |
| Specialty | PHYSICIAN ASSISTANT |
| City + Specialty | CARBONDALE + PHYSICIAN ASSISTANT |
Please comment or provide details below to improve the information on Robert Bruce Herzog.
| Data Provider | Centers for Medicare & Medicaid Services (CMS) |
| Jurisdiction | Medicare |
This dataset includes 1.12 million groups, individual physicians, and other clinicians currently enrolled in Medicare. Each physician is registered with NPI, PAC ID, full name, specialty, phone, organization, hospital, address, medical school, etc.