Individual provider Active NPI

Jennifer T Bergin, M.D.

  • Diagnostic Radiology Physician
  • Waukesha, WI
National Provider Identifier
1093766172
Registry record updated Dec 14, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Diagnostic Radiology PhysicianTaxonomy code 2085R0202X
License
47164 Issued in WI
Practice address
725 American Ave
Waukesha, WI 53188-5031
Phone
(262) 928-2400
NPI assigned
May 13, 2006
Last updated
Dec 14, 2012By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 14, 2012

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Diagnostic Radiology Physician 2085R0202X 47164 WI Primary

Addresses

Primary practice location

725 American Ave
Waukesha, WI 53188-5031

Mailing address

725 American Ave
Waukesha, WI 53188-5031
Phone (262) 928-2400

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20070713000797 WI Practitioner - Diagnostic Radiology 3577663962 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Diagnostic Radiology
Education
University of Wisconsin School of Medicine, 2003
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Radiology Waukesha SCGroup PAC ID 3274520648, 29 clinicians
Prohealth Medical Group IncGroup PAC ID 3476465188, 475 clinicians

Practice addresses (Care Compare)

N16W24131 Riverwood Dr
Waukesha, WI 53188-1106
Phone (262) 696-5580

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
47164WIMDDiagnostic Radiology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Prohealth Medical Group Inc. CurrentSince Oct 15, 2012 Accepting new patients
Prohealth Medical Group Inc CurrentSince Oct 15, 2012 Accepting new patients
Radiology Waukesha S.C. Diagnostic Radiology CurrentSince Jul 1, 2008 Accepting new patients
Prohealth Medical Group Inc Past Accepting new patients

Locations

W168N11237 Western Ave
Germantown, WI 53022
Phone (262) 253-5060

125 Hospital Dr
Watertown, WI 53098
Phone (920) 261-4210

725 American Ave
Waukesha, WI 53188
Phone (262) 544-2011

N14W23900 Stone Ridge Dr
Waukesha, WI 53188
Phone (262) 549-3030

N16W24131 Riverwood Dr
Waukesha, WI 53188
Phone (262) 696-0696

N17W24100 Riverwood Dr
Waukesha, WI 53188
Phone (262) 820-3093

Interoperability endpoints

  • Direct secure messaging: jbergin14726@direct.phci.org

Organizations & group practices 4

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": "1147478400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1355443200000",
    "number": "1093766172",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "725 AMERICAN AVE",
            "city": "WAUKESHA",
            "state": "WI",
            "postal_code": "531885031",
            "telephone_number": "262-928-2400"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "725 AMERICAN AVE",
            "city": "WAUKESHA",
            "state": "WI",
            "postal_code": "531885031",
            "telephone_number": "262-928-2400"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BERGIN",
        "first_name": "JENNIFER",
        "middle_name": "T",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-05-13",
        "last_updated": "2012-12-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2085R0202X",
            "taxonomy_group": "",
            "desc": "Radiology, Diagnostic Radiology",
            "state": "WI",
            "license": "47164",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Waukesha, WI

Sources for this page

Verify at the official NPI Registry.