Active NPI
Thor Christian Bergersen, M.D.
- Psychiatry Physician
- Needham, MA
National Provider Identifier
1013112796
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Psychiatry Physician
- License
- 204123
- Practice address
- 75 2ND Ave
Suite 310
Needham, MA 02494-2820 - Phone
- (781) 726-6698
- Fax
- (781) 726-6725
- NPI assigned
- Jun 20, 2007
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Psychiatry Physician | 2084P0800X | 204123 | MA | Primary |
Addresses
Primary practice location
75 2ND Ave
Suite 310
Needham, MA 02494-2820
Mailing address
75 2ND Ave
Suite 310
Needham, MA 02494-2820
Phone (781) 726-6698
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: Yes
- Opted out of Medicare
- Yes, effective Jul 1, 2015 through Jul 1, 2027
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 204123 | MA | MD | Psychiatry Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Docthor P.C. | Past | Accepting new patients | |
| Hallowell Center | Past | Accepting new patients | |
| Child and Family Psychological Services, PLLC | Psychiatry | Past | Accepting new patients |
| Psychological Care Associates, P.C. | Psychiatry | Past | Accepting new patients |
Organizations & group practices 4
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- Adult Mental Health Clinic/Center
- Needham, MA
- NPI 1952708968
-
- Psychologist
- Needham, MA
- NPI 1073843249
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1182297600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1013112796",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "75 2ND AVE",
"address_2": "SUITE 310",
"city": "NEEDHAM",
"state": "MA",
"postal_code": "024942820",
"telephone_number": "781-726-6698",
"fax_number": "781-726-6725"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "75 2ND AVE",
"address_2": "SUITE 310",
"city": "NEEDHAM",
"state": "MA",
"postal_code": "024942820",
"telephone_number": "781-726-6698",
"fax_number": "781-726-6725"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BERGERSEN",
"first_name": "THOR",
"middle_name": "CHRISTIAN",
"name_prefix": "Dr.",
"credential": "M.D.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2007-06-20",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "2084P0800X",
"taxonomy_group": "",
"desc": "Psychiatry & Neurology, Psychiatry",
"state": "MA",
"license": "204123",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Needham, MA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring; Opt Out Affidavits.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.