Active NPI
Jolene Kay Berg, M.D.
- Family Medicine Physician
- Edina, MN
National Provider Identifier
1104858786
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Medicine Physician
- License
- 26194
- Practice address
- 308 Dearborn Court
Edina, MN 55343-2000 - Phone
- (612) 718-8984
- Fax
- (210) 426-3787
- NPI assigned
- Jul 6, 2006
- Sex
- Female
- 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 |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | 26194 | MN | Primary |
Addresses
Primary practice location
308 Dearborn Court
Edina, MN 55343-2000
Mailing address
308 Dearborn Court
Edina, MN 55343-2000
Phone (612) 718-8984
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 806479600 | Medicaid | ID |
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)
- Enrolled
- Credentials
- Doctor of Medicine
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Schertz Primary Care | Family Medicine | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1152144000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1542585600000",
"number": "1104858786",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "308 DEARBORN COURT",
"city": "EDINA",
"state": "MN",
"postal_code": "553432000",
"telephone_number": "612-718-8984",
"fax_number": "210-426-3787"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "308 DEARBORN COURT",
"city": "EDINA",
"state": "MN",
"postal_code": "553432000",
"telephone_number": "612-718-8984",
"fax_number": "210-426-3787"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BERG",
"first_name": "JOLENE",
"middle_name": "KAY",
"name_prefix": "Dr.",
"credential": "M.D.",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-07-06",
"last_updated": "2018-11-19",
"status": "A"
},
"taxonomies": [
{
"code": "207Q00000X",
"taxonomy_group": "",
"desc": "Family Medicine",
"state": "MN",
"license": "26194",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "806479600",
"state": "ID"
}
],
"endpoints": [],
"other_names": []
}Other providers in Edina, MN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 19, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.