Tod L Berg, M.D., P.C.

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

2644771205 Issued in UT

Legal business name

TOD L BERG, M.D., P.C.

Practice address

1467 S Highway 40
Heber City, UT 84032-3522

Phone

(435) 654-6321

Fax

(435) 654-6364

NPI assigned

Jul 29, 2008

Organization subpart

No

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

Authorized official

Name

Dr. Tod L Berg, M.D.

Title

Owner

Phone

(435) 654-6321

Specialties & licenses 1

Addresses

Other identifiers 3

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

{
    "created_epoch": "1217289600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1217376000000",
    "number": "1245496355",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1467 S HIGHWAY 40",
            "city": "HEBER CITY",
            "state": "UT",
            "postal_code": "840323522",
            "telephone_number": "435-654-6321",
            "fax_number": "435-654-6364"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1467 S HIGHWAY 40",
            "city": "HEBER CITY",
            "state": "UT",
            "postal_code": "840323522",
            "telephone_number": "435-654-6321",
            "fax_number": "435-654-6364"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "TOD L BERG, M.D., P.C.",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-07-29",
        "last_updated": "2008-07-30",
        "status": "A",
        "authorized_official_last_name": "BERG",
        "authorized_official_first_name": "TOD",
        "authorized_official_middle_name": "L",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "435-654-6321",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Family Medicine",
            "state": "UT",
            "license": "2644771205",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ORGANIZATIONAL NPI",
            "identifier": "1245496355",
            "state": "UT"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "529061882001",
            "state": "UT"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "INDIVIDUAL NPI",
            "identifier": "1497713648",
            "state": "UT"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 30, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.