KARL HERMAN M.D.
NPI 1003253063
Internal Medicine in Providence, RI

Q: What is Karl Herman's NPI number?

The NPI number for Karl Herman is 1003253063. It was assigned to this individual provider in the NPPES registry on May 31, 2013.

Q: What is Karl Herman's specialty?

The primary specialty registered for this NPI is Internal Medicine with taxonomy code 207R00000X.

Q: When was this NPI record last updated?

The NPPES record for Karl Herman was last updated on June 10, 2016. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 10 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.

Active since May 31, 2013PECOS EnrolledAccepts Medicare Assignment

164 SUMMIT AVE, FAIN BLDG., PROVIDENCE, RI 02906(401) 793-4489(401) 793-4047 Get Directions Write a Review

NPPES record last updated: June 10, 2016. Verified against the NPPES registry weekly; last sync: October 18, 2026.

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About Karl Herman M.d. NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

KARL HERMAN M.D. (NPI 1003253063) is an individual internal medicine provider in Providence, Rhode Island, licensed in Rhode Island (MD15316) and active in the NPI registry since May 2013. He is enrolled in Medicare PECOS, is affiliated with Morton Hospital, and is a graduate of Other (2013).

NPPES Registry Identity

NPI1003253063

Entity TypeIndividualMale

Primary Taxonomy207R00000X

Provider Legal NameKARL HERMANCredential: M.D.

Location Address164 SUMMIT AVE, FAIN BLDG.Providence, RI 02906-2853

Mailing Address164 Summit Ave, Fain Bldg.Providence, RI 02906-2853 · (401) 793-4489 · Fax (401) 793-4047

Phone(401) 793-4489

Fax(401) 793-4047

Sole ProprietorNo

Medical School CMSOtherGraduated 2013

Enumeration DateMay 31, 2013

Last NPPES UpdateJune 10, 2016

✔ NPI 1003253063 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyInternal MedicineAllopathic & Osteopathic Physicians

Taxonomy Code207R00000X

License✔ Licensed in RI · MD15316

Definition

A physician who provides long-term, comprehensive care in the office and the hospital, managing both common and complex illness of adolescents, adults and the elderly. Internists are trained in the diagnosis and treatment of cancer, infections and diseases affecting the heart, blood, kidneys, joints and digestive, respiratory and vascular systems. They are also trained in the essentials of primary care internal medicine, which incorporates an understanding of disease prevention, wellness, substance abuse, mental health and effective treatment of common problems of the eyes, ears, skin, nervous system and reproductive organs.

164 SUMMIT AVE, Providence, RI 02906

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Medicare Participation & PECOS CMS

Medicare enrollment, assignment, billing reassignment, and ordering and referring status from CMS.

Medicare Enrollment Status

✔

Enrolled in Medicare and accepts Medicare assignment

Karl Herman M.d. is registered in PECOS and agrees to accept the Medicare-approved amount as full payment. Medicare patients are not billed beyond the standard deductible and coinsurance.

PECOS PAC ID840417259

PECOS Enrollment IDI20160803000113

Eligible to Order & Refer✔ Part B Labs & Imaging✔ Durable Medical Equipment✔ Home Health Agency✔ Power Mobility DevicesPer the CMS Ordering and Referring file. Eligibility means Medicare pays claims that this provider orders or refers for these categories.

Medicare Billing Reassignments

Medicare enrollment records show Karl Herman reassigns Medicare billing to 3 organizations. Each organization bills Medicare for the services this provider delivers there; the nearest is listed first.

Lifespan Physician Group Inc

0.4 mi

Urology

195 COLLYER ST STE 201
Providence, RI 02904

Reassigned Medicare billing, Rhode Island enrollment
1,372 clinicians in this Medicare group

NPI 1720949803 (401) 272-7799

Lifespan Physician Group Of Massachusetts Inc

16 mi

Family Medicine

2007 BAY ST
Taunton, MA 02780

Reassigned Medicare billing, Massachusetts enrollment
547 clinicians in this Medicare group

NPI 1235957713 (774) 409-2009

Hospital Medicine Associates LLC

1,344 mi

Hospitalist

17000 MEDICAL CENTER DR
Baton Rouge, LA 70816

Reassigned Medicare billing, Rhode Island enrollment
77 clinicians in this Medicare group

NPI 1093758781 (225) 752-2470

Source: CMS Revalidation Reassignment List, October 2026 release. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.

Areas of Expertise CMS Part B claims 5

Services this provider delivered to Medicare fee-for-service patients, from the CMS Medicare utilization data. Higher counts generally reflect more experience with a service; care delivered outside Medicare is not included.

Subsequent hospital care with moderate levelof medical decision making, if using time, at least 50 minutes 99233

Follow-up hospital inpatient care per day typically involves a 35-minute check-up by your healthcare provider. This service includes monitoring your health progress, adjusting your treatment plan if needed, and answering any questions you may have about your condition or care.

146 services83 patients

Initial hospital care with moderate level of medical decision making, if using time, at least 75 minutes 99223

Initial hospital inpatient care per day, typically 70 minutes, refers to the daily medical service provided to patients admitted to the hospital. This includes a comprehensive evaluation, diagnosis, treatment plan, and monitoring of your health condition. It ensures your well-being during your hospital stay.

78 services76 patients

Hospital discharge day management, more than 30 minutes 99239

Hospital discharge day management over 30 minutes involves a detailed process to ensure a smooth transition from hospital to home. It includes final examinations, discussion of your hospital stay, post-discharge instructions, and coordinating follow-up care.

74 services72 patients

Hospital discharge day management, 30 minutes or less 99238

Hospital discharge day management of 30 minutes or less includes finalizing your treatment, discussing your progress, and planning after-care at home. It ensures you're ready to leave the hospital and continue recovery safely.

17 services17 patients

Initial hospital care with straightforward or low-level medical decision making, if using time, at least 55 minutes 99222

Initial hospital inpatient care is a service where a healthcare provider spends about 50 minutes per day overseeing your care while you're admitted in the hospital. This includes reviewing your health status, planning your treatment, and ensuring your safety and comfort.

12 services12 patients

Hospital Affiliations CMS Care Compare 4

Hospitals where this provider delivers care, identified from recent Medicare claims and place-of-service records.

Morton Hospital

Acute Care Hospitals · Taunton, MA

1/5 CMS rating

OwnershipProprietary

CMS Certification Number220073

Location88 Washington StreetTaunton, MA 02780 · Bristol County

Emergency services

Rhode Island Hospital

Acute Care Hospitals · Providence, RI

3/5 CMS rating

OwnershipTribal

CMS Certification Number410007

Location593 Eddy StreetProvidence, RI 02903 · Providence County

Emergency services

The Miriam Hospital

Acute Care Hospitals · Providence, RI

5/5 CMS rating

OwnershipVoluntary non-profit - Private

CMS Certification Number410012

Location164 Summit AvenueProvidence, RI 02906 · Providence County

Emergency services

Westerly Hospital

Acute Care Hospitals · Westerly, RI

5/5 CMS rating

OwnershipVoluntary non-profit - Private

CMS Certification Number410013

Location25 Wells StreetWesterly, RI 02891 · Washington County

Emergency services

Physician Visit Costs CMS claims · ZIP area

Typical Medicare office-visit costs in the 02906 ZIP code area, from fee-for-service claims. These are area statistics, not this provider’s prices; actual charges vary by service and coverage.

New Patient

$134.17 typical visit price

range $58.57 – $177.03

Typical copayment $33.54 (range $14.64 – $44.25)

Most-billed visit code 99204

Established Patient

$103.10 typical visit price

range $18.92 – $144.38

Typical copayment $25.77 (range $4.73 – $36.09)

Most-billed visit code 99214

Amounts reflect what Medicare beneficiaries in this ZIP area are typically charged for office visits. Patients with other coverage should check their individual plans.

Referred Medical Equipment & Supplies CMS DME claims 2

Durable medical equipment, devices and supplies this provider ordered from DME suppliers for patients, from Medicare fee-for-service claims.

Portable gaseous oxygen system, rental; includes portable container, regulator, flowmeter, humidifier, cannula or mask, and tubing E0431

DME-Oxygen and Supplies · category DC000N

2 suppliers20 claims21 services$14.55 avg. paid by Medicare

Oxygen concentrator, single delivery port, capable of delivering 85 percent or greater oxygen concentration at the prescribed flow rate E1390

DME-Oxygen and Supplies · category DC002N

2 suppliers20 claims21 services$65.49 avg. paid by Medicare

Dollar amounts are the average Medicare paid the supplier per service. They are not the cost to the patient.

Other Providers at the Same Location NPPES 20

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

MRS. HALINA KUC-MAZGAJ

Nurse Practitioner (Family)

164 SUMMIT AVE, THE MIRIAM HOSPITAL
PROVIDENCE, RI 02906

Providence County (401) 793-3902

MUHAMMAD BAIG M.D.

Internal Medicine (Cardiovascular Disease)

164 SUMMIT AVE, FAIN BLDG
PROVIDENCE, RI 02906

Providence County (401) 793-4489

MS. LEANNE LAPARLE LICSW

Social Worker (Clinical)