Samantha Bergoine, D.C.

Primary specialty

ChiropractorTaxonomy code 111N00000X

License

CH13852 Issued in FL

Practice address

3042 S Ridgewood Ave
Edgewater, FL 32141-5903

Phone

(386) 287-1372

NPI assigned

Apr 5, 2022

Reactivated

Mar 21, 2023

Last updated

Mar 21, 2023By the provider in NPPES

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Pure Chiropractic & Yoga

  dba Edge Fit Chiropractic

  • Chiropractor
  • Edgewater, FL
  • NPI 1134827207
  NPD Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1649116800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1679356800000",
    "number": "1114668019",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2819 S ASCIANO CT",
            "city": "NEW SMYRNA BEACH",
            "state": "FL",
            "postal_code": "321686322"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3042 S RIDGEWOOD AVE",
            "city": "EDGEWATER",
            "state": "FL",
            "postal_code": "321415903",
            "telephone_number": "386-287-1372"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2819 S Asciano Ct",
            "address_purpose": "LOCATION",
            "city": "New Smyrna Beach",
            "state": "FL",
            "postal_code": "321686322",
            "country_code": "US",
            "telephone_number": "954-610-9738",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "BERGOINE",
        "first_name": "SAMANTHA",
        "name_prefix": "Dr.",
        "credential": "D.C.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2022-04-05",
        "last_updated": "2023-03-21",
        "certification_date": "2023-03-21",
        "deactivation_date": "2023-02-04",
        "reactivation_date": "2023-03-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "",
            "desc": "Chiropractor",
            "state": "FL",
            "license": "CH13852",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Chiropractor in Edgewater, FL
• Providers in Edgewater, FL by specialty
• Chiropractor in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 21, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.