Individual provider Active NPI

Elizabeth M Berg, CPNP

  • Pediatric Nurse Practitioner
  • Columbia, SC
National Provider Identifier
1104866771
Registry record updated Jun 30, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatric Nurse PractitionerTaxonomy code 363LP0200X
License
APN142 Issued in SC
Practice address
9 Richland Medical Park Dr Ste 500
Columbia, SC 29203-6870
Phone
(803) 434-4555
Fax
(803) 434-4599
NPI assigned
Jun 8, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 30, 2021

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatric Nurse Practitioner 363LP0200X APN142 SC Primary

Addresses

Primary practice location

9 Richland Medical Park Dr Ste 500
Columbia, SC 29203-6870

Mailing address

PO Box 743904
Atlanta, GA 30374-3904
Phone (803) 296-7320

Other identifiers 2

IdentifierTypeStateIssuer
AA3422F935OtherSCMEDICARE
NP1724MedicaidSC

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address eberg377059@direct.ghs.myhfn.org Direct

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in SC
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20080509000600 SC Practitioner - Nurse Practitioner 8022197409 Reassigns benefits to 2 organizations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Certified Pediatric Nurse Practitioner, Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
APN142SCMDPediatric Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Eau Claire Cooperative Health Center, Inc. Current Accepting new patients
Prisma Health Medical Group-Midlands CurrentSince Nov 27, 2016 Accepting new patients
Eau Claire Cooperative Health Center, Inc. CurrentSince Feb 10, 2016 Accepting new patients
Eau Claire Cooperative Health Center ,Inc. CurrentSince Feb 10, 2016 Accepting new patients
Prisma Health Medical Group-Midlands CurrentSince Nov 27, 2016 Accepting new patients

Locations

9 Richland Medical Park Dr
Ste 450
Columbia, SC 29203
Phone (803) 434-8800

9 Richland Medical Park Dr
#42
Columbia, SC 29203
Phone (803) 434-2833

4605 Monticello Rd
Columbia, SC 29203
Phone (803) 252-7001

2 Medical Park Rd
Ste 506
Columbia, SC 29203
Phone (803) 434-3930

1228 Harden St
Ste B
Columbia, SC 29204
Phone (803) 744-0540

9 Richland Medical Park Dr
Ste 420
Columbia, SC 29203
Phone (803) 434-2833

9 Richland Medical Park Dr
Ste 500
Columbia, SC 29203
Phone (803) 344-4555

Interoperability endpoints

  • Direct secure messaging: eberg377059@direct.ghs.myhfn.org

Organizations & group practices 5

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": "1149724800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1625011200000",
    "number": "1104866771",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 743904",
            "city": "ATLANTA",
            "state": "GA",
            "postal_code": "303743904",
            "telephone_number": "803-296-7320",
            "fax_number": "803-296-7330"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9 RICHLAND MEDICAL PARK DR STE 500",
            "city": "COLUMBIA",
            "state": "SC",
            "postal_code": "292036870",
            "telephone_number": "803-434-4555",
            "fax_number": "803-434-4599"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BERG",
        "first_name": "ELIZABETH",
        "middle_name": "M",
        "credential": "CPNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-06-08",
        "last_updated": "2021-06-30",
        "certification_date": "2021-06-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LP0200X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Pediatrics",
            "state": "SC",
            "license": "APN142",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE",
            "identifier": "AA3422F935",
            "state": "SC"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "NP1724",
            "state": "SC"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "eberg377059@direct.ghs.myhfn.org",
            "affiliation": "N",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "eberg377059@direct.ghs.myhfn.org",
            "address_1": "9 Richland Medical Park Dr Ste 500",
            "city": "Columbia",
            "state": "SC",
            "country_code": "US",
            "postal_code": "292036870",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Columbia, SC

Sources for this page

Verify at the official NPI Registry.