NPIMap

Individual provider Active NPI

Boris O Bergus, MD

  • Emergency Medicine Physician
  • East Greenwich, RI
National Provider Identifier
1013975382
Registry record updated Jul 5, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Emergency Medicine PhysicianTaxonomy code 207P00000X
License
79021 Issued in MA
Practice address
1407 S County TRL Ste 431
East Greenwich, RI 02818-1679
Phone
(508) 769-2707
Fax
(508) 480-8260
NPI assigned
May 3, 2006
Last updated
Jul 5, 2022By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 5, 2022

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Emergency Medicine Physician 207P00000X 79021 MA Primary

Addresses

Primary practice location

1407 S County TRL Ste 431
East Greenwich, RI 02818-1679

Mailing address

1407 S County TRL Ste 431
East Greenwich, RI 02818-1679
Phone (508) 769-2707

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

Practice roles

OrganizationSpecialtyStatusNew patients
Saint Vincent Physician Services, Inc. PastSince Aug 17, 2010 Accepting new patients
Emergency Medicine Physicians of Providence County, LLC Emergency Medicine Past Accepting new patients
Ambulatory Care Physicians at CDH, PC Emergency Medicine Past Accepting new patients

Organizations & group practices 7

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1146614400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1656979200000",
    "number": "1013975382",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1407 S COUNTY TRL STE 431",
            "city": "EAST GREENWICH",
            "state": "RI",
            "postal_code": "028181679",
            "telephone_number": "508-769-2707",
            "fax_number": "508-480-8260"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1407 S COUNTY TRL STE 431",
            "city": "EAST GREENWICH",
            "state": "RI",
            "postal_code": "028181679",
            "telephone_number": "508-769-2707",
            "fax_number": "508-480-8260"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BERGUS",
        "first_name": "BORIS",
        "middle_name": "O",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-05-03",
        "last_updated": "2022-07-05",
        "certification_date": "2022-07-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "MA",
            "license": "79021",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in East Greenwich, RI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 5, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.