Daniel Berg, ARDMS/ARRT

Key facts

NPI

1154581536

Entity type

Individual (NPI type 1)

Primary specialty

Radiologic Technologist 247100000X

License

ARDMS5701 (SD)

Practice address

420 4TH St NE Ste 122
Watertown, SD 57201-2658

Phone

(605) 886-5709

Fax

(605) 886-5723

NPI assigned

Jun 10, 2008

Sex

Male

Sole proprietor

No

Medicare participation

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

National Provider Directory

Medicare enrollment (NPD)

No

State licenses

Specialties & licenses

Addresses

The complete NPPES record for this NPI in the NPI Registry API JSON format, last updated by the provider on Jun 10, 2008.

{
    "created_epoch": "1213056000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1213056000000",
    "number": "1154581536",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "420 4TH ST NE STE 122",
            "city": "WATERTOWN",
            "state": "SD",
            "postal_code": "572012658",
            "telephone_number": "605-886-5709",
            "fax_number": "605-886-5723"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "420 4TH ST NE STE 122",
            "city": "WATERTOWN",
            "state": "SD",
            "postal_code": "572012658",
            "telephone_number": "605-886-5709",
            "fax_number": "605-886-5723"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BERG",
        "first_name": "DANIEL",
        "credential": "ARDMS/ARRT",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2008-06-10",
        "last_updated": "2008-06-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "247100000X",
            "taxonomy_group": "",
            "desc": "Radiologic Technologist",
            "state": "SD",
            "license": "ARDMS5701",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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All providers in Watertown, SD · Radiologic Technologist in South Dakota