Kelsey Ann Bergeron

Primary specialty

DentistTaxonomy code 122300000X

License

062750 Issued in NY

Practice address

1730 Niagara Falls Blvd Ste 300
Tonawanda, NY 14150-7531

Phone

(716) 831-2277

NPI assigned

Feb 18, 2021

Last updated

Sep 12, 2022By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in LA

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

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

{
    "created_epoch": "1613606400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1662940800000",
    "number": "1154914216",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1730 NIAGARA FALLS BLVD STE 300",
            "city": "TONAWANDA",
            "state": "NY",
            "postal_code": "141507531",
            "telephone_number": "716-831-2277"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1730 NIAGARA FALLS BLVD STE 300",
            "city": "TONAWANDA",
            "state": "NY",
            "postal_code": "141507531",
            "telephone_number": "716-831-2277"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "540 Longmeadow Rd Apt 2",
            "address_purpose": "LOCATION",
            "city": "Amherst",
            "state": "NY",
            "postal_code": "142262400",
            "country_code": "US",
            "telephone_number": "607-745-4237",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "BERGERON",
        "first_name": "KELSEY",
        "middle_name": "ANN",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2021-02-18",
        "last_updated": "2022-09-12",
        "certification_date": "2022-09-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "NY",
            "license": "062750",
            "primary": true
        },
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Danielle Page Bellamy Simmons, DNP
• William J Belles, MD
• Shanyn Benden, RN
• Kristin Elizabeth Benk, LPN
• Donna Marie Berdzik, PT, DPT
• John Arthur Berndt, PHARMD
• Michael Sanford Bernstein, DPM
• Christopher John Beutel, RN
• Marlene Beyer, CCC/SLP
• Melissa Bigelow, PT

• Dentist in Tonawanda, NY
• Providers in Tonawanda, NY by specialty
• Dentist in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 12, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.