NPIMap

Individual provider Active NPI

Jonathon H Berg, MD

  • Family Medicine Physician
  • Grand Forks, ND
National Provider Identifier
1073513982
Registry record updated Jul 21, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
5113 Issued in ND
Practice address
1300 South Columbia Road
Grand Forks, ND 58201-4032
Phone
(701) 780-5000
Fax
(701) 587-6009
NPI assigned
Jul 21, 2005
Last updated
Jul 21, 2022By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 21, 2022

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 5113 ND Primary

Addresses

Primary practice location

1300 South Columbia Road
Grand Forks, ND 58201-4032

Mailing address

PO Box 6002
Grand Forks, ND 58201
Phone (701) 780-5000

Other identifiers 7

IdentifierTypeStateIssuer
01-19160OtherMEDICA
23749OtherNDND BCBS
514800600MedicaidMN
NA9481022061OtherPREFERRED ONE
917187OtherFIRST HEALTH (MAILHANDLERS)
12955MedicaidND
268M0BEOtherMNMN BCBS

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in ND
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
I20040611000275 ND Practitioner - Family Practice 3173506904 Reassigns benefits to 5 organizations

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
University of Minnesota Medical School, 1982
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Nelson County Health SystemGroup PAC ID 5597658104, 7 clinicians

Practice addresses (Care Compare)

108 N Main St
McVille, ND 58254-4203
Phone (701) 322-4347

4 N Park St
Northwood, ND 58267-4102
Phone (701) 587-6060

PO Box
Suite 367
McVille, ND 58254

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
5113NDMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Northwood Deaconess Health Center CurrentSince Feb 1, 2002 Accepting new patients
Cooperstown Medical Center Current Accepting new patients
Northwood Deaconess Health Center Current Accepting new patients
Northwood Deaconess Health Center CurrentSince Feb 1, 2002 Accepting new patients
Cooperstown Medical Center CurrentSince Dec 27, 2014 Accepting new patients
Cooperstown Medical Center CurrentSince Dec 27, 2014 Accepting new patients
Aneta Nursing Home Incorporated Past Accepting new patients
Griggs County Nursing Home Past Accepting new patients
The Evangelical Lutheran Good Samaritan Society Past Accepting new patients
Nelson County Health System Past Accepting new patients

Locations

107 12th St S
Cooperstown, ND 58425
Phone (701) 786-1700

1200 Roberts Ave NE
Cooperstown, ND 58425
Phone (701) 797-2128

611 Towner Ave
Larimore, ND 58251
Phone (701) 431-2999

Ownership & related parties

All facility ownership & control disclosures 2

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
Aneta Parkview Health CenterAneta, ND, CCN 355096 Skilled nursing facility Operational/Managerial Control
Adp of the SNF		 Nov 1, 1994
Nov 1, 1994
Good Samaritan Society - LakotaLakota, ND, CCN 355104 Skilled nursing facility Contracted Managing Employee Jan 1, 2019

Owned or controlled facilities with NPI records 2

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

Organizations & group practices 12

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.

Hospital & facility affiliations 4

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1121904000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1658361600000",
    "number": "1073513982",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 6002",
            "city": "GRAND FORKS",
            "state": "ND",
            "postal_code": "58201",
            "telephone_number": "701-780-5000",
            "fax_number": "701-587-6009"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1300 SOUTH COLUMBIA ROAD",
            "city": "GRAND FORKS",
            "state": "ND",
            "postal_code": "582014032",
            "telephone_number": "701-780-5000",
            "fax_number": "701-587-6009"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BERG",
        "first_name": "JONATHON",
        "middle_name": "H",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-07-21",
        "last_updated": "2022-07-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "ND",
            "license": "5113",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICA",
            "identifier": "01-19160",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ND BCBS",
            "identifier": "23749",
            "state": "ND"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "514800600",
            "state": "MN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PREFERRED ONE",
            "identifier": "NA9481022061",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "FIRST HEALTH (MAILHANDLERS)",
            "identifier": "917187",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "12955",
            "state": "ND"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MN BCBS",
            "identifier": "268M0BE",
            "state": "MN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Grand Forks, ND

Sources for this page

Verify at the official NPI Registry.