Bernie Rex Hershberger, PH.D.

Primary specialty

PsychologistTaxonomy code 103T00000X

License

PY61087867 Issued in WA

Practice address

221 33Rd Ave E
Seattle, WA 98112-4909

Phone

(207) 837-9377

NPI assigned

Jan 28, 2022

Sex

Male

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

Opted out of Medicare

Yes, effective Jan 10, 2024 through Jan 10, 2028

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Philosophy

State licenses

Practice roles

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.

• E. Merle Bragdon, PHD, PA

  • Clinical Psychologist
  • Portland, ME
  • NPI 1598069312
  NPD (past)

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

{
    "created_epoch": "1643328000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1643328000000",
    "number": "1154074300",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "221 33RD AVE E",
            "city": "SEATTLE",
            "state": "WA",
            "postal_code": "981124909",
            "telephone_number": "207-837-9377"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "221 33RD AVE E",
            "city": "SEATTLE",
            "state": "WA",
            "postal_code": "981124909",
            "telephone_number": "207-837-9377"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HERSHBERGER",
        "first_name": "BERNIE",
        "middle_name": "REX",
        "credential": "PH.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2022-01-28",
        "last_updated": "2022-01-28",
        "certification_date": "2022-01-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103T00000X",
            "taxonomy_group": "",
            "desc": "Psychologist",
            "state": "WA",
            "license": "PY61087867",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Kacy J Herron, MD
• Sheyanne Herron
• Elizabeth Hersey
• Tia Renee Hershaw
• Robert M Hershberg, MD PHD
• John Hershberger
• Leah Hershberger, MD
• Meghan Hershkowitz
• Olivia Hershman
• Maureen Hersholt, LMHC

• Psychologist in Seattle, WA
• Providers in Seattle, WA by specialty
• Psychologist in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 28, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Opt Out Affidavits.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.