Active NPI
Gary Lee Berger, MD
- Urology Physician
- Port Charlotte, FL
National Provider Identifier
1205818804
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Urology Physician
- License
- ME0030516
- Practice address
- 2400 Harbor Blvd
Suite 21
Port Charlotte, FL 33952-5052 - Phone
- (941) 625-6992
- Fax
- (941) 625-7238
- NPI assigned
- Nov 18, 2005
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Urology Physician | 208800000X | ME0030516 | FL | Primary |
Addresses
Primary practice location
2400 Harbor Blvd
Suite 21
Port Charlotte, FL 33952-5052
Mailing address
2234 Colonial Blvd
Managed Care Department
Fort Myers, FL 33907-1412
Phone (239) 931-7342
Other identifiers 7
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 25028 | Other | FL | BCBS PROVIDER # |
| 217124 | Other | FL | AVMED |
| 47450 | Other | FL | BCBS OF FL |
| 002736800 | Medicaid | FL | |
| 8707000 | Other | FL | CIGNA PROVIDER # |
| 8707000 | Other | FL | CIGNA |
| 1192904 | Other | FL | WELLCARE |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| ME0030516 | FL | MD | Urology Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1132272000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1461542400000",
"number": "1205818804",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2234 COLONIAL BLVD",
"address_2": "MANAGED CARE DEPARTMENT",
"city": "FORT MYERS",
"state": "FL",
"postal_code": "339071412",
"telephone_number": "239-931-7342",
"fax_number": "239-931-7385"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2400 HARBOR BLVD",
"address_2": "SUITE 21",
"city": "PORT CHARLOTTE",
"state": "FL",
"postal_code": "339525052",
"telephone_number": "941-625-6992",
"fax_number": "941-625-7238"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BERGER",
"first_name": "GARY",
"middle_name": "LEE",
"name_prefix": "Dr.",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2005-11-18",
"last_updated": "2016-04-25",
"status": "A"
},
"taxonomies": [
{
"code": "208800000X",
"taxonomy_group": "",
"desc": "Urology",
"state": "FL",
"license": "ME0030516",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BCBS PROVIDER #",
"identifier": "25028",
"state": "FL"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "AVMED",
"identifier": "217124",
"state": "FL"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BCBS OF FL",
"identifier": "47450",
"state": "FL"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "002736800",
"state": "FL"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "CIGNA PROVIDER #",
"identifier": "8707000",
"state": "FL"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "CIGNA",
"identifier": "8707000",
"state": "FL"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "WELLCARE",
"identifier": "1192904",
"state": "FL"
}
],
"endpoints": [],
"other_names": []
}Other providers in Port Charlotte, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 25, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.