Douglas Alan Bergstrom, PH.D.

Primary specialty

Clinical PsychologistTaxonomy code 103TC0700X

License

1142 Issued in AZ

Practice address

143 E Merritt St
Prescott, AZ 86301-2028

Phone

(928) 445-3835

Fax

(928) 445-7071

NPI assigned

Mar 19, 2007

Last updated

Jul 8, 2007By the provider in NPPES

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in AZ

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Clinical Psychologist

Education

Other, 1983

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Philosophy

Practice roles

Locations

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.

• Douglas a. Bergstrom, PH.D., PLLC

  • Community/Behavioral Health Agency
  • Prescott, AZ
  • NPI 1154501682
  Medicare reassignment NPD Authorized official

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

{
    "created_epoch": "1174262400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1063536688",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "143 E MERRITT ST",
            "city": "PRESCOTT",
            "state": "AZ",
            "postal_code": "863012028",
            "telephone_number": "928-445-3835",
            "fax_number": "928-445-7071"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "143 E MERRITT ST",
            "city": "PRESCOTT",
            "state": "AZ",
            "postal_code": "863012028",
            "telephone_number": "928-445-3835",
            "fax_number": "928-445-7071"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BERGSTROM",
        "first_name": "DOUGLAS",
        "middle_name": "ALAN",
        "credential": "PH.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-03-19",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "AZ",
            "license": "1142",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Anne M Benson, FNPC
• Bradley Vernon Benson, D.O.
• Brian David Benson, D.C
• Eric Bequary, PHARMACIST
• August Henry Bergman, M.D.
• Michael Berlowe, APRN, FNP-C
• Melanie Corinne Bernal
• Brian Zachary Bernier, ND
• Christina Bernier
• Andrea Bernkrant, LCSW

• Clinical Psychologist in Prescott, AZ
• Providers in Prescott, AZ by specialty
• Clinical Psychologist in Arizona

• 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.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.