Active NPI
Larry F Berger, MD
- Psychiatry Physician
- Eden Prairie, MN
National Provider Identifier
1104803568
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Psychiatry Physician
- License
- 29521
- Practice address
- 7525 Mitchell Road
Suite 200B
Eden Prairie, MN 55344-1957 - Phone
- (952) 657-5452
- Fax
- (952) 657-5453
- NPI assigned
- Dec 28, 2005
- Sex
- Male
- 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 |
|---|---|---|---|---|
| Psychiatry Physician | 2084P0800X | 29521 | MN | Primary |
Addresses
Primary practice location
7525 Mitchell Road
Suite 200B
Eden Prairie, MN 55344-1957
Mailing address
7525 Mitchell Road
Suite 200B
Eden Prairie, MN 55344-1957
Phone (952) 657-5452
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 342392100 | Medicaid | MN |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: Yes
- Opted out of Medicare
- Yes, effective Jul 20, 2010 through Jul 20, 2028
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 29521 | MN | MD | Psychiatry Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1135728000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1280966400000",
"number": "1104803568",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "7525 MITCHELL ROAD",
"address_2": "SUITE 200B",
"city": "EDEN PRAIRIE",
"state": "MN",
"postal_code": "553441957",
"telephone_number": "952-657-5452",
"fax_number": "952-657-5453"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "7525 MITCHELL ROAD",
"address_2": "SUITE 200B",
"city": "EDEN PRAIRIE",
"state": "MN",
"postal_code": "553441957",
"telephone_number": "952-657-5452",
"fax_number": "952-657-5453"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BERGER",
"first_name": "LARRY",
"middle_name": "F",
"name_prefix": "Dr.",
"credential": "MD",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2005-12-28",
"last_updated": "2010-08-05",
"status": "A"
},
"taxonomies": [
{
"code": "2084P0800X",
"taxonomy_group": "",
"desc": "Psychiatry & Neurology, Psychiatry",
"state": "MN",
"license": "29521",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "342392100",
"state": "MN"
}
],
"endpoints": [],
"other_names": []
}Other providers in Eden Prairie, MN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 5, 2010; 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; Opt Out Affidavits.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.