Individual provider Active NPI

Jeremy Dean Berger, MD

  • Surgery Physician
  • Mankato, MN
National Provider Identifier
1154558682
Registry record updated Jul 9, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Surgery PhysicianTaxonomy code 208600000X
License
57694 Issued in MN
Practice address
1230 E Main St
Mankato, MN 56001-5066
Phone
(507) 625-1811
NPI assigned
Jun 11, 2009
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 9, 2020

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Surgery Physician 208600000X 2009 MO
Surgery Physician 208600000X 57694 MN Primary

Addresses

Primary practice location

1230 E Main St
Mankato, MN 56001-5066

Mailing address

1230 E Main St
Mankato, MN 56001-5066
Phone (507) 625-1811

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address jeremyberger@mklt.allscriptsdirect.net Direct

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20140602001302 MN Practitioner - General Surgery 5597909887 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
General Surgery
Education
State University of Ny Upstate Medical University, 2009
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Mankato Clinic LTD 243 clinicians

Practice addresses (Care Compare)

1025 Marsh St
Mankato, MN 56001-4752
Phone (507) 385-2983

1230 E Main St
Mankato, MN 56001-5066
Phone (507) 389-8509

1230 Main St E
PO Box 8674
Mankato, MN 56002-8674
Phone (507) 625-1811

1900 Sunrise Dr
Saint Peter, MN 56082-5376
Phone (507) 931-2200

Hospital & facility affiliations

  • Mayo Clinic Health System - Mankato Hospital, Mankato, MN, CCN 240093
  • River'S Edge Hospital & Clinic Hospital, St Peter, MN, CCN 241334

Procedures performed for Medicare patients

ProcedureNumber of procedures
Colonoscopy22
Hernia repair - groin (open)1-10
Hernia repair (minimally invasive)1-10
Mastectomy11
Melanoma (skin cancer) excision1-10
Removal of tissue1-10
Skin biopsy1-10

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
2009MOMDInternal Medicine Physician
57694MNMDSurgery Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Mankato Clinic LTD Surgery CurrentSince Jul 1, 2014 Accepting new patients

Locations

1230 E Main St
Mankato, MN 56001
Phone (507) 389-8502

Interoperability endpoints

  • Direct secure messaging: jeremyberger@mklt.allscriptsdirect.net

Ownership & related parties

All facility ownership & control disclosures 1

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
Open Door Health CenterMankato, MN, CCN 241857 Federally qualified health center Corporate Director Jun 1, 2022

Owned or controlled facilities with NPI records 1

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

Organizations & group practices 1

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": "1244678400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1594252800000",
    "number": "1154558682",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1230 E MAIN ST",
            "city": "MANKATO",
            "state": "MN",
            "postal_code": "560015066",
            "telephone_number": "507-625-1811"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1230 E MAIN ST",
            "city": "MANKATO",
            "state": "MN",
            "postal_code": "560015066",
            "telephone_number": "507-625-1811"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BERGER",
        "first_name": "JEREMY",
        "middle_name": "DEAN",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2009-06-11",
        "last_updated": "2020-07-09",
        "certification_date": "2020-07-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208600000X",
            "taxonomy_group": "",
            "desc": "Surgery",
            "state": "MO",
            "license": "2009",
            "primary": false
        },
        {
            "code": "208600000X",
            "taxonomy_group": "",
            "desc": "Surgery",
            "state": "MN",
            "license": "57694",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "jeremyberger@mklt.allscriptsdirect.net",
            "affiliation": "N",
            "endpointDescription": "Mankato Clinic Direct ID, Allscripts Community",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "1230 E Main St",
            "city": "Mankato",
            "state": "MN",
            "country_code": "US",
            "postal_code": "560015066",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Mankato, MN

Sources for this page

Verify at the official NPI Registry.