Active NPI
Michael S. Bergman, PH.D.
- Clinical Psychologist
- Austin, TX
National Provider Identifier
1265631014
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Psychologist
- License
- 33417
- Practice address
- 2630 Exposition Blvd Ste 116
Austin, TX 78703-1758 - Phone
- (512) 417-2723
- NPI assigned
- Jul 12, 2007
- Last updated
- Jul 22, 2026
- Sex
- Male
- Sole proprietor
- Yes
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 |
|---|---|---|---|---|
| Clinical Psychologist | 103TC0700X | 33417 | TX | Primary |
Addresses
Primary practice location
2630 Exposition Blvd Ste 116
Austin, TX 78703-1758
Mailing address
508 Ann St
Wilmington, NC 28401-4608
Phone (512) 417-2723
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)
- Not enrolled
- Credentials
- Doctor of Philosophy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 33417 | TX | MD | Pharmacist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1184198400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1784678400000",
"number": "1265631014",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "508 ANN ST",
"city": "WILMINGTON",
"state": "NC",
"postal_code": "284014608",
"telephone_number": "512-417-2723"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2630 EXPOSITION BLVD STE 116",
"city": "AUSTIN",
"state": "TX",
"postal_code": "787031758",
"telephone_number": "512-417-2723"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BERGMAN",
"first_name": "MICHAEL",
"middle_name": "S.",
"name_prefix": "Dr.",
"credential": "PH.D.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2007-07-12",
"last_updated": "2026-07-22",
"certification_date": "2026-07-22",
"status": "A"
},
"taxonomies": [
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "TX",
"license": "33417",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Austin, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 22, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.