Active NPI
Julia Rose Bergquist, MD
- Internal Medicine Physician
- Maywood, IL
National Provider Identifier
1104627017
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Internal Medicine Physician
- License
- 125.085247
- Practice address
- 2160 S 1St Ave
Maywood, IL 60153-3328 - Phone
- (888) 548-7888
- NPI assigned
- Mar 24, 2025
- Sex
- Female
- Sole proprietor
- Yes
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 |
|---|---|---|---|---|
| Internal Medicine Physician | 207R00000X | 125.085247 | IL | Primary |
Addresses
Primary practice location
2160 S 1St Ave
Maywood, IL 60153-3328
Mailing address
39989 N Prairie View Dr
Wadsworth, IL 60083-9609
Phone (847) 909-4345
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in IL
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: Yes
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20250625004019 | IL | Order and Referring Only - Internal Medicine | 4385156108 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 125.085247 | IL | MD | Internal Medicine Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1742774400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1747353600000",
"number": "1104627017",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "39989 N PRAIRIE VIEW DR",
"city": "WADSWORTH",
"state": "IL",
"postal_code": "600839609",
"telephone_number": "847-909-4345"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2160 S 1ST AVE",
"city": "MAYWOOD",
"state": "IL",
"postal_code": "601533328",
"telephone_number": "888-548-7888"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BERGQUIST",
"first_name": "JULIA",
"middle_name": "ROSE",
"credential": "MD",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2025-03-24",
"last_updated": "2025-05-16",
"certification_date": "2025-05-16",
"status": "A"
},
"taxonomies": [
{
"code": "207R00000X",
"taxonomy_group": "",
"desc": "Internal Medicine",
"state": "IL",
"license": "125.085247",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Maywood, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 16, 2025; 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.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.