Individual provider Active NPI

Theresa Marie Bergin, PA-C

  • Physician Assistant
  • Orlando, FL
National Provider Identifier
1114170222
Registry record updated Sep 2, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
PA9104797 Issued in FL
Practice address
1507 S Hiawassee Rd
Ste 107
Orlando, FL 32835-5706
Phone
(407) 445-9545
Fax
(407) 299-9141
NPI assigned
Nov 3, 2008
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 2, 2026

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X PA9104797 FL Primary
Medical Physician Assistant 363AM0700X PA9104797 FL

Addresses

Primary practice location

1507 S Hiawassee Rd
Ste 107
Orlando, FL 32835-5706

Mailing address

1507 S Hiawassee Rd
Ste 107
Orlando, FL 32835-5706
Phone (407) 445-9545

Other practice location 1

380 Celebration Pl # 2
Celebration, FL 34747-4606
Phone (407) 303-4078

Other practice location 2

616 E Altamonte Dr
Altamonte Spring, FL 32701-4802
Phone (407) 303-2328

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in FL
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
I20090123000589 FL Practitioner - Physician Assistant 6305906959 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2008
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Florida Med-Psych Consultants LLCGroup PAC ID 5799115713, 20 clinicians

Practice addresses (Care Compare)

1507 S Hiawassee Rd
Suite 206
Orlando, FL 32835-5719
Phone 4074459545222

Hospital & facility affiliations

  • Adventhealth Orlando Hospital, Orlando, FL, CCN 100007

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Florida Hospital Medical Group Inc Physician Assistant CurrentSince Aug 17, 2020 Accepting new patients
Florida Hospital Medical Group Inc CurrentSince Aug 17, 2020 Accepting new patients

Locations

380 Celebration Pl
#2
Kissimmee, FL 34747
Phone (407) 303-2422

2600 Westhall Ln
Ste 4
Maitland, FL 32751
Phone (407) 200-2700

601 E Rollins St
Orlando, FL 32803
Phone (407) 303-1996

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 and National Provider Directory roles.

Hospital & facility affiliations 2

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": "1225670400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1788307200000",
    "number": "1114170222",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1507 S HIAWASSEE RD",
            "address_2": "STE 107",
            "city": "ORLANDO",
            "state": "FL",
            "postal_code": "328355706",
            "telephone_number": "407-445-9545",
            "fax_number": "407-299-9141"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1507 S HIAWASSEE RD",
            "address_2": "STE 107",
            "city": "ORLANDO",
            "state": "FL",
            "postal_code": "328355706",
            "telephone_number": "407-445-9545",
            "fax_number": "407-299-9141"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "380 Celebration Pl # 2",
            "address_purpose": "LOCATION",
            "city": "Celebration",
            "state": "FL",
            "postal_code": "347474606",
            "country_code": "US",
            "telephone_number": "407-303-4078",
            "fax_number": "407-303-4803",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "616 E Altamonte Dr",
            "address_purpose": "LOCATION",
            "city": "Altamonte Spring",
            "state": "FL",
            "postal_code": "327014802",
            "country_code": "US",
            "telephone_number": "407-303-2328",
            "fax_number": "407-303-2332",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "BERGIN",
        "first_name": "THERESA",
        "middle_name": "MARIE",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2008-11-03",
        "last_updated": "2026-09-02",
        "certification_date": "2026-09-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "FL",
            "license": "PA9104797",
            "primary": true
        },
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "FL",
            "license": "PA9104797",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Orlando, FL

Sources for this page

Verify at the official NPI Registry.