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THOMAS R HARTZELL MD
NPI 1619966256
Obstetrics & Gynecology in Saint Clair Shores, MI

Active since October 17, 2005PECOS EnrolledAccepts Medicare Assignment
86.85/100
CMS Quality Rating
21000 E 12 MILE RD, STE 102, SAINT CLAIR SHORES, MI 48081(800) 848-0202(586) 226-6949 Get Directions Write a Review

NPPES record last updated: September 9, 2019. Verified against the NPPES registry weekly; last sync: August 02, 2026.

About Thomas R Hartzell Md NPPES

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

THOMAS R HARTZELL MD (NPI 1619966256) is an individual obstetrics & gynecology provider in Saint Clair Shores, Michigan, licensed in Michigan (4301052970) and active in the NPI registry since October 2005. He is enrolled in Medicare PECOS, is affiliated with Ascension St John Hospital, and is a graduate of Wayne State University School Of Medicine (1988).

NPPES Registry Identity

NPI1619966256
Entity TypeIndividualMale
Primary Taxonomy207V00000X
Provider Legal NameTHOMAS R HARTZELLCredential: MD
Location Address21000 E 12 MILE RD, STE 102Saint Clair Shores, MI 48081-1156
Mailing Address21000 E 12 Mile Rd, Ste 102Saint Clair Shores, MI 48081-1156 · (800) 848-0202 · Fax (586) 226-6949
Phone(800) 848-0202
Fax(586) 226-6949
Sole ProprietorNo
Medical School CMSWayne State University School Of MedicineGraduated 1988
Enumeration DateOctober 17, 2005
Last NPPES UpdateSeptember 9, 2019
✔ NPI 1619966256 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyObstetrics & GynecologyAllopathic & Osteopathic Physicians
Taxonomy Code207V00000X
License✔ Licensed in MI · 4301052970
Definition
An obstetrician/gynecologist possesses special knowledge, skills and professional capability in the medical and surgical care of the female reproductive system and associated disorders. This physician serves as a consultant to other physicians and as a primary physician for women.
21000 E 12 MILE RD, Saint Clair Shores, MI 48081
Open in Google Maps ↗

Accepted Insurance

The full list of accepted plans is on the Insurance tab. Issuers include Blue Care Network of Michigan, Blue Cross Blue Shield of Michigan Mutual Insurance Company, McLaren Health Plan Community and more.Insurance ›

Medicare Participation & PECOS CMS

Medicare enrollment, assignment, and ordering and referring status from the CMS PECOS system.

Medicare Enrollment Status

✔

Enrolled in Medicare and accepts Medicare assignment

Thomas R Hartzell Md 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 ID8123163342
PECOS Enrollment IDI20100226000514
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.

Areas of Expertise CMS Part B claims 4

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.

Established patient office or other outpatient visit with low level od decision making, if using time, 20 minutes or more 99213
This is a routine visit for patients who have already been seen by the healthcare provider. During this approximately 20-29 minute appointment, your health status will be evaluated and any necessary treatments or tests will be discussed. It's a chance to address any health concerns you may have.
68 services37 patients
Cervical or vaginal cancer screening; pelvic and clinical breast examination G0101
This procedure involves checking for health issues in the lower abdomen and chest area. It helps identify early signs of certain conditions, increasing the chance for successful treatment. It's a routine check-up that's important for maintaining good health.
63 services63 patients
Screening papanicolaou smear; obtaining, preparing and conveyance of cervical or vaginal smear to laboratory Q0091
A Papanicolaou smear, often called a Pap smear, is a test to check for changes in cells. A small sample is gently collected from the lower region and sent to a lab for examination. This helps in early detection of potential health issues.
36 services36 patients
Annual depression screening, 5 to 15 minutes G0444
An annual depression screening is a short, routine evaluation to check for signs of depression. It involves answering a series of questions about your feelings, thoughts, and behaviors. The process takes about 15 minutes and helps detect depression early for better management.
18 services18 patients

Hospital Affiliations CMS Care Compare 2

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

Ascension St John Hospital

Acute Care Hospitals · Detroit, MI
2/5 CMS rating
OwnershipVoluntary non-profit - Church
CMS Certification Number230165
Location22101 Moross RdDetroit, MI 48236 · Wayne County
Emergency services Birthing friendly

Ascension Macomb Oakland Hosp-Warren Campus

Acute Care Hospitals · Warren, MI
2/5 CMS rating
OwnershipVoluntary non-profit - Private
CMS Certification Number230195
Location11800 East Twelve Mile RoadWarren, MI 48093 · Macomb County
Emergency services

Physician Visit Costs CMS claims · ZIP area

Typical Medicare office-visit costs in the 48081 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
$134.28 typical visit price
range $58.04 – $177.36
Typical copayment $33.57 (range $14.51 – $44.34)
Most-billed visit code 99204
Established Patient
$72.38 typical visit price
range $18.32 – $143.49
Typical copayment $18.09 (range $4.58 – $35.87)
Most-billed visit code 99213
Amounts reflect what Medicare beneficiaries in this ZIP area are typically charged for office visits. Patients with other coverage should check their individual plans.

Medicare Quality Performance CMS QPP · MIPS

Performance in the CMS Quality Payment Program: the MIPS final score across four weighted categories, and the individual quality measures reported to Medicare.

86.85/100
MIPS Final ScoreMerit-based Incentive Payment System · CMS Quality Payment Program
Scored as part of a group practice
Quality84.71
Promoting Interoperability100
Improvement Activities40
Cost65.3

Reported Quality Measures

Breast Cancer Screening
Percentage of women 50-74 years of age who had a mammogram to screen for breast cancer
86%401 patients4/55-star benchmark: 92%
Cervical Cancer Screening
Percentage of women 21-64 years of age who were screened for cervical cancer using either of the following criteria: - Women age 21-64 who had cervical cytology performed every 3 years - Women age 30-64 who had cervical cytology/human papillomavirus (HPV)…
95%1,074 patients
Colorectal Cancer Screening
Percentage of adults 50-75 years of age who had appropriate screening for colorectal cancer
43%439 patients3/55-star benchmark: 85%
e-Prescribing
At least one permissible prescription written by the MIPS eligible clinician is queried for a drug formulary and transmitted electronically using certified EHR technology.
98%1,838 patients4/55-star benchmark: 99%
Medication Reconciliation
The MIPS eligible clinician performs medication reconciliation for at least one transition of care in which the patient is transitioned into the care of the MIPS eligible clinician.
100%244 patients5/55-star benchmark: 100%
Patient-Specific Education
The MIPS eligible clinician must use clinically relevant information from CEHRT to identify patient-specific educational resources and provide access to those materials to at least one unique patient seen by the MIPS eligible clinician.
62%1,554 patients3/55-star benchmark: 97%
Preventive Care and Screening: Body Mass Index (BMI) Screening and Follow-Up Plan
Percentage of patients aged 18 years and older with a BMI documented during the current encounter or during the previous twelve months AND with a BMI outside of normal parameters, a follow-up plan is documented during the encounter or during the previous…
55%1,337 patients3/55-star benchmark: 97%
Preventive Care and Screening: Tobacco Use: Screening and Cessation Intervention
Percentage of patients aged 18 years and older who were screened for tobacco use one or more times within 24 months AND who received tobacco cessation intervention if identified as a tobacco user
Patients screenedForUse: 99% · 1,075 patients
Patients tobacco: 5% · 64 patients
85%1,075 patients4/55-star benchmark: 98%
Provide Patient Access
At least one patient seen by the MIPS eligible clinician during the performance period is provided timely access to view online, download, and transmit to a third party their health information subject to the MIPS eligible clinician's discretion to withhold…
94%1,554 patients4/55-star benchmark: 100%
Secure Messaging
For at least one unique patient seen by the MIPS eligible clinician during the performance period, a secure message was sent using the electronic messaging function of CEHRT to the patient (or the patient-authorized representative), or in response to a secure…
90%1,554 patients5/55-star benchmark: 89%
View, Download, or Transmit (VDT)
At least one patient seen by the MIPS eligible clinician during the performance period (or patient-authorized representative) views, downloads or transmits their health information to a third party during the performance period.
68%1,554 patients
Providers report different measures because they deliver different services; reporting more or less information is not a reflection of quality. Star ratings appear only where CMS assigned them.

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.

DR. DOUGLAS CARL KUBEK D.O.
Otolaryngology (Sleep Medicine)
21000 E 12 MILE RD, STE 111
SAINT CLAIR SHORES, MI 48081
Macomb County (586) 779-7610
LAKESHORE EAR NOSE AND THROAT CENTER PC
Otolaryngology
21000 E 12 MILE RD, SUITE 111
SAINT CLAIR SHORES, MI 48081
Macomb County (586) 779-7610
MARY E MARKOVICH
Audiologist-Hearing Aid Fitter
21000 E 12 MILE RD, STE 111
SAINT CLAIR SHORES, MI 48081
Macomb County (586) 779-7610
DR. MICHAEL S FOZO MD
Otolaryngology (Plastic Surgery within the Head & Neck)
21000 E 12 MILE RD, SUITE 111
SAINT CLAIR SHORES, MI 48081
Macomb County (586) 779-7610
ANN R MCREYNOLDS MD
Obstetrics & Gynecology
21000 E 12 MILE RD, 102
ST CLAIR SHORES, MI 48081
Macomb County (586) 447-5100
NATHAN S. WHITE MD
Obstetrics & Gynecology
21000 E 12 MILE RD
ST CLAIR SHORES, MI 48081
Macomb County (586) 447-5100
LAKESHORE EAR NOSE AND THROAT CENTER PC
Allergy & Immunology
21000 E 12 MILE RD, STE 111
SAINT CLAIR SHORES, MI 48081
Macomb County (586) 779-7610
MRS. ELIZABETH THERESE PARUS CRNA
Nurse Anesthetist, Certified Registered
21000 E 12 MILE RD
SAINT CLAIR SHORES, MI 48081
Macomb County (586) 447-5021

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Thomas Hartzell's NPI number?

The NPI number for Thomas Hartzell is 1619966256. It was assigned to this individual provider in the NPPES registry on October 17, 2005.

Where is Thomas Hartzell located?

Thomas Hartzell practices at 21000 E 12 Mile Rd Ste 102, Saint Clair Shores, MI 48081. The listed phone number is (800) 848-0202.

What is Thomas Hartzell's specialty?

The primary specialty registered for this NPI is Obstetrics & Gynecology with taxonomy code 207V00000X.

Is Thomas Hartzell enrolled in Medicare?

Yes. Thomas Hartzell is registered in the Medicare PECOS system and accepts Medicare assignment, which means accepting the Medicare-approved amount as payment in full for covered services.

What insurance does Thomas Hartzell accept?

Health plans from Blue Care Network of Michigan, Blue Cross Blue Shield of Michigan Mutual Insurance Company, McLaren Health Plan Community and Priority Health list Thomas Hartzell as in-network in at least one marketplace plan. Coverage varies by plan and year; verify with the insurer or the provider before a visit.

Is Thomas Hartzell affiliated with any hospitals?

According to CMS data, Thomas Hartzell is affiliated with Ascension St John Hospital and Ascension Macomb Oakland Hosp-Warren Campus.

When was this NPI record last updated?

The NPPES record for Thomas Hartzell was last updated on September 9, 2019. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 6 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.