Elizabeth Bergamini
Individual provider Active NPI Pediatrics Physician · Manchester, MO
NPI 1154740629 · NPPES record last updated Apr 7, 2025
Key facts
- NPI
- 1154740629
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Pediatrics Physician 208000000X
- License
- 2017010207 (MO)
- Practice address
- 1511 Ploma Dr
Manchester, MO 63021-7048 - Phone
- (314) 304-8298
- NPI assigned
- Apr 14, 2014
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 5
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in MO
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20180403001990 | MO | Practitioner - Pediatric Medicine | 0244532711 | Reassigns benefits to 2 organizations |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 2017010207 | MO | MD | Pediatrics Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| SSM Health Care St Louis | Current |
Accepting new patients | |
| SSM Health Care Group | Current |
Accepting new patients | |
| SSM Health Care Group | Pediatrics | Current |
Accepting new patients |
| SSM Health Care St. Louis | Current |
Accepting new patients | |
| SSM Health Care St. Louis | Past | Accepting new patients |
Locations
7344 Solutions Ctr
Chicago, IL 60677
Phone (314) 989-6189
1015 Bowles Ave
Fenton, MO 63026
Phone (636) 496-2000
1465 S Grand Blvd
Saint Louis, MO 63104
Phone (314) 268-4070
10101 Woodfield Ln
Saint Louis, MO 63132
Phone (608) 280-4647
Interoperability endpoints
- ebergamini112911@direct-ehr-ssmhc.com
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Hospitalist Physician | 208M00000X | 2017010207 | MO | |
| Student in an Organized Health Care Education/Training Program | 390200000X | |||
| Pediatrics Physician | 208000000X | 2017010207 | MO | Yes |
Addresses
Primary practice location
1511 Ploma Dr
Manchester, MO 63021-7048
Mailing address
1511 Ploma Dr
Manchester, MO 63021-7048
Phone (314) 304-8298
Other providers in Manchester, MO
- Adrienne Nicole Barrow
- Hannah Baublitz
- Sarah Beninato
- Julia A Bennett
- Lindsay Benoist
- Robert A Bertolino
- Best Love & Care Home Services, LLC
- Timothi J. Beth
- Amy Bias
- Frank Joseph Bier
All providers in Manchester, MO · Pediatrics Physician in Missouri
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Apr 7, 2025. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.