Paul W Bergamini, DC
Individual provider Active NPI Chiropractor · Cody, WY
NPI 1053486480 · NPPES record last updated Jun 18, 2009
Key facts
- NPI
- 1053486480
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Chiropractor 111N00000X
- License
- 614 (WY)
- Practice address
- 1543 Bleistein Avenue
Cody, WY 82414 - Phone
- (307) 587-4600
- Fax
- (307) 527-6949
- NPI assigned
- Nov 21, 2006
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 2
Medicare Care Compare profile
- Specialty
- Chiropractic
- Education
- Palmer College Chiropractic - Davenport, 1976
- Medicare assignment
- May accept Medicare assignment
Practice addresses (Care Compare)
1543 Bleistein Ave
Cody, WY 82414-3806
Phone (307) 587-4600
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in WY
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20040226000031 | WY | Practitioner - Chiropractic | 5092601070 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 614 | WY | MD | Clinical Social Worker |
| 1220 | CO | MD | Physician Assistant |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Heart Mountain Chiropractic | Chiropractor | Current |
Accepting new patients |
| Heart Mountain Chiropractic Inc | Chiropractor | Past |
Accepting new patients |
Locations
1543 Bleistein Ave
Cody, WY 82414
Phone (307) 527-5469
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Chiropractor | 111N00000X | 614 | WY | Yes |
| Chiropractor | 111N00000X | 1220 | CO |
Addresses
Primary practice location
1543 Bleistein Avenue
Cody, WY 82414
Mailing address
PO Box 1403
Cody, WY 82414
Phone (307) 587-7060
Other providers in Cody, WY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jun 18, 2009. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.