NPIMap

Individual provider Active NPI

Michaela Ilyse Miller-Bergeron

  • Physician Assistant
  • Fishersville, VA
National Provider Identifier
1194563064
Registry record updated Jul 16, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
0110010213 Issued in VA
Practice address
100 Baldwin Blvd
Fishersville, VA 22939-2375
Phone
(540) 887-4000
NPI assigned
Jul 16, 2024
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 16, 2024

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X 0110010213 VA Primary

Addresses

Primary practice location

100 Baldwin Blvd
Fishersville, VA 22939-2375

Mailing address

100 Baldwin Blvd
Fishersville, VA 22939-2375

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20240831000603 VA Practitioner - Physician Assistant 3072052232 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2024
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Gastrointestinal Specialists LLCGroup PAC ID 5294797957, 79 clinicians

Practice addresses (Care Compare)

6602 W Broad St
Suite B
Richmond, VA 23230-1702
Phone (804) 285-8206

8266 Atlee Rd
Suite 133
Mechanicsville, VA 23116-1805
Phone (804) 285-8206

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

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 9

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": "1721088000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1721088000000",
    "number": "1194563064",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "100 BALDWIN BLVD",
            "city": "FISHERSVILLE",
            "state": "VA",
            "postal_code": "229392375"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "100 BALDWIN BLVD",
            "city": "FISHERSVILLE",
            "state": "VA",
            "postal_code": "229392375",
            "telephone_number": "540-887-4000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MILLER-BERGERON",
        "first_name": "MICHAELA",
        "middle_name": "ILYSE",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2024-07-16",
        "last_updated": "2024-07-16",
        "certification_date": "2024-07-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "VA",
            "license": "0110010213",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Fishersville, VA

Sources for this page

Verify at the official NPI Registry.