Active NPI
Randy J Bergsma, PHARM.D
- Pharmacotherapy Pharmacist
- South Haven, MI
National Provider Identifier
1093225708
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacotherapy Pharmacist
- License
- 5302041961
- Practice address
- 1223 Phoenix St
South Haven, MI 49090-7911 - Phone
- (269) 639-3510
- Fax
- (269) 639-3565
- NPI assigned
- Oct 8, 2017
- Last updated
- Oct 8, 2017
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacotherapy Pharmacist | 1835P1200X | 5302041961 | MI | Primary |
Addresses
Primary practice location
1223 Phoenix St
South Haven, MI 49090-7911
Mailing address
4495 Walleye Dr SW
Walker, MI 49534-6574
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)
- Not enrolled
- Credentials
- Doctor of Pharmacy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 5302041961 | MI | MD | Pharmacotherapy Pharmacist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Meijer Inc | Past | Accepting new patients | |
| Meijer, Inc. | Past | Accepting new patients |
Organizations & group practices 2
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": "1507420800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1507420800000",
"number": "1093225708",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4495 WALLEYE DR SW",
"city": "WALKER",
"state": "MI",
"postal_code": "495346574"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1223 PHOENIX ST",
"city": "SOUTH HAVEN",
"state": "MI",
"postal_code": "490907911",
"telephone_number": "269-639-3510",
"fax_number": "269-639-3565"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BERGSMA",
"first_name": "RANDY",
"middle_name": "J",
"name_prefix": "Dr.",
"credential": "PHARM.D",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2017-10-08",
"last_updated": "2017-10-08",
"status": "A"
},
"taxonomies": [
{
"code": "1835P1200X",
"taxonomy_group": "",
"desc": "Pharmacist, Pharmacotherapy",
"state": "MI",
"license": "5302041961",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in South Haven, MI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 8, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.