NPIMap

Individual provider Active NPI

Rosemary Bergeron-Johnson, PAC

  • Physician Assistant
  • Yakima, WA
National Provider Identifier
1043255318
Registry record updated Jul 8, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
PA10004865 Issued in WA
Practice address
110 S 9TH Ave
Yakima, WA 98902-3315
Phone
(509) 575-5061
NPI assigned
Jun 19, 2006
Last updated
Jul 8, 2007By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 8, 2007

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X PA10004865 WA Primary

Addresses

Primary practice location

110 S 9TH Ave
Yakima, WA 98902-3315

Mailing address

266 Massapoag Ave
Sharon, MA 02067-2713
Phone (478) 719-8328

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in GA
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20070103000263 GA Practitioner - Physician Assistant 7113956103 Reassigns benefits to 8 organizations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

State licenses

LicenseStateTypeSpecialty
2255GAMDPsychologist

Practice roles

OrganizationSpecialtyStatusNew patients
Houston County Emergency Group, LLC CurrentSince Mar 1, 2015 Accepting new patients
Choice Family Medicine, PC Current Accepting new patients
Odell Still DO LLC PastSince Nov 1, 2014 Accepting new patients
Houston Emergency Physicians LLC Past Accepting new patients
Washington Em-I Medical Services PC Past Accepting new patients
Sterling Emergency Services of the Southeast Inc Past Accepting new patients

Locations

201 Woodrow Wilson Dr
Valdosta, GA 31602
Phone (229) 241-0041

1601 Watson Blvd
Warner Robins, GA 31093
Phone (478) 322-5155

Organizations & group practices 14

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.

View all 14

NPI Registry JSON

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

{
    "created_epoch": "1150675200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1043255318",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "266 MASSAPOAG AVE",
            "city": "SHARON",
            "state": "MA",
            "postal_code": "020672713",
            "telephone_number": "478-719-8328"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "110 S 9TH AVE",
            "city": "YAKIMA",
            "state": "WA",
            "postal_code": "989023315",
            "telephone_number": "509-575-5061"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BERGERON-JOHNSON",
        "first_name": "ROSEMARY",
        "credential": "PAC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-06-19",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "WA",
            "license": "PA10004865",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Yakima, WA

Sources for this page

Verify at the official NPI Registry.