NPIMap

Individual provider Active NPI

Robert John Berg, M.D.

  • Specialist
  • Meridian, MS
National Provider Identifier
1114901063
Registry record updated Jan 8, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
SpecialistTaxonomy code 174400000X
License
06978 Issued in MS
Practice address
2024 15TH St
Suite 500
Meridian, MS 39301-4130
Phone
(601) 482-5174
Fax
(601) 482-5175
NPI assigned
Dec 5, 2005
Last updated
Jan 8, 2008By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 8, 2008

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Specialist 174400000X 06978 MS Primary

Addresses

Primary practice location

2024 15TH St
Suite 500
Meridian, MS 39301-4130

Mailing address

2024 15TH St
Suite 500
Meridian, MS 39301-4130
Phone (601) 482-5174

Other identifiers 2

IdentifierTypeStateIssuer
73006066OtherMSBLUE CROSS ALABAMA
00018061MedicaidMS

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MS
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20041213000527 MS Practitioner - General Surgery 0840256079 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
General Surgery
Education
University of Mississippi School of Medicine, 1974
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Rush Medical FoundationGroup PAC ID 2567368541, 31 clinicians

Practice addresses (Care Compare)

905 C S Frontage Rd
Ochsner Urgent Care Meridian
Meridian, MS 39301-6113
Phone (601) 482-4955

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
06978MSMDSpecialist

Practice roles

OrganizationSpecialtyStatusNew patients
Anderson Regional Medical Center Specialist CurrentSince Dec 5, 1988 Accepting new patients
Anderson Regional Medical Center CurrentSince Dec 5, 1988 Accepting new patients
Rush Medical Foundation Current Accepting new patients
Rush Medical Foundation CurrentSince Jul 2, 2019 Accepting new patients
Anderson Regional Medical Center Current Accepting new patients
Rush Medical Foundation CurrentSince Jul 2, 2019 Accepting new patients
Anderson Regional Medical Center Current Accepting new patients

Locations

1102 Constitution Ave
#F
Meridian, MS 39301
Phone (601) 693-2511

1102 Constitution Ave
Fl 2
Meridian, MS 39301
Phone (601) 484-7900

2124 14th St
Meridian, MS 39301
Phone (601) 483-8811

603 S Archusa Ave
Quitman, MS 39355
Phone (601) 776-2123

Interoperability endpoints

  • FHIR API: https://fhir.nextgen.com/nge/prod/fhir-api-r4/fhir/r4/

Organizations & group practices 8

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.

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": "1133740800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1199750400000",
    "number": "1114901063",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2024 15TH ST",
            "address_2": "SUITE 500",
            "city": "MERIDIAN",
            "state": "MS",
            "postal_code": "393014130",
            "telephone_number": "601-482-5174",
            "fax_number": "601-482-5175"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2024 15TH ST",
            "address_2": "SUITE 500",
            "city": "MERIDIAN",
            "state": "MS",
            "postal_code": "393014130",
            "telephone_number": "601-482-5174",
            "fax_number": "601-482-5175"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BERG",
        "first_name": "ROBERT",
        "middle_name": "JOHN",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-12-05",
        "last_updated": "2008-01-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "",
            "desc": "Specialist",
            "state": "MS",
            "license": "06978",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS ALABAMA",
            "identifier": "73006066",
            "state": "MS"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00018061",
            "state": "MS"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Meridian, MS

Sources for this page

Verify at the official NPI Registry.