Individual provider Active NPI

Nathaniel Benjamin Berg, MD

  • Vascular & Interventional Radiology Physician
  • Tamuning, GU
National Provider Identifier
1265646806
Registry record updated Dec 9, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Vascular & Interventional Radiology PhysicianTaxonomy code 2085R0204X
License
M-1142 Issued in GU
Practice address
633 Governor Carlos Camacho Road
Suite 210
Tamuning, GU 96913
Phone
(671) 649-1001
Fax
(671) 649-1002
NPI assigned
May 10, 2007
Last updated
Dec 9, 2019By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 9, 2019

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

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
Nuclear Radiology Physician 2085N0904X M-1142 GU
Diagnostic Radiology Physician 2085R0202X M-1142 GU
Vascular & Interventional Radiology Physician 2085R0204X M-1142 GU Primary
Interventional Pain Medicine Physician 208VP0014X M-1142 GU

Addresses

Primary practice location

633 Governor Carlos Camacho Road
Suite 210
Tamuning, GU 96913

Mailing address

633 Governor Carlos Camacho Road
Suite 210
Tamuning, GU 96913
Phone (671) 649-1001

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20170703001328 GU Practitioner - Diagnostic RadiologyPractitioner - Interventional Radiology 0244129922 Reassigns benefits to 4 organizations

Care Compare profile

Medicare Care Compare
Specialty
Diagnostic Radiology
Education
Tufts University School of Medicine, 1990
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Guam Medical Imaging Center LLCGroup PAC ID 6103715842, 7 clinicians
Guam X-RayGroup PAC ID 8123180742, 33 clinicians

Practice addresses (Care Compare)

133 Route 3
Dededo, GU 96929-6911
Phone (671) 645-5500

633 Gov Carlos Camacho Rd
Suite 210
Tamuning, GU 96913

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
91.74 of 100Reported as group
Quality
77.93
Improvement activities
40

Merit-based Incentive Payment System (MIPS)

Final score
65.1 of 100Reported as group
Quality
100
Promoting interoperability
0
Improvement activities
30
Cost
79.51

Merit-based Incentive Payment System (MIPS)

Final score
79.22 of 100Reported as group
Quality
78.84
Improvement activities
40
Cost
61.61

Procedures performed for Medicare patients

ProcedureNumber of procedures
Removal of tissue1-10

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
M-1142GUMDNuclear Radiology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Guam Healthcare Development Incorporated CurrentSince Apr 17, 2020 Accepting new patients
Guam X-Ray Diagnostic Radiology CurrentSince Jul 1, 1999 Accepting new patients
Commonwealth Healthcare Corporation CurrentSince Nov 9, 2019 Accepting new patients
Pacific Cardiology Consultants LLC PastSince Jun 27, 2012 Accepting new patients
Pacific Urology Consultants LLC PastSince Jul 15, 2011 Accepting new patients

Locations

133 Route 3
Dededo, GU 96929
Phone (671) 645-5500

633 Gov Carlos G Camacho Rd
Ste 206
Tamuning, GU 96913
Phone (671) 649-1001

633 Gov Carlos G Camacho Rd
Ste 210
Tamuning, GU 96913
Phone (671) 649-1001

633 Gov Carlos G Camacho Rd
Ste 218
Tamuning, GU 96913
Phone (671) 649-9227

850 Gov Carlos G Camacho Rd
#R
Tamuning, GU 96913
Phone (671) 647-2552

Organizations & group practices 8

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 2

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": "1178755200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1575849600000",
    "number": "1265646806",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "633 GOVERNOR CARLOS CAMACHO ROAD",
            "address_2": "SUITE 210",
            "city": "TAMUNING",
            "state": "GU",
            "postal_code": "96913",
            "telephone_number": "671-649-1001",
            "fax_number": "671-649-1002"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "633 GOVERNOR CARLOS CAMACHO ROAD",
            "address_2": "SUITE 210",
            "city": "TAMUNING",
            "state": "GU",
            "postal_code": "96913",
            "telephone_number": "671-649-1001",
            "fax_number": "671-649-1002"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BERG",
        "first_name": "NATHANIEL",
        "middle_name": "BENJAMIN",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-05-10",
        "last_updated": "2019-12-09",
        "certification_date": "2019-12-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2085N0904X",
            "taxonomy_group": "",
            "desc": "Radiology, Nuclear Radiology",
            "state": "GU",
            "license": "M-1142",
            "primary": false
        },
        {
            "code": "2085R0202X",
            "taxonomy_group": "",
            "desc": "Radiology, Diagnostic Radiology",
            "state": "GU",
            "license": "M-1142",
            "primary": false
        },
        {
            "code": "2085R0204X",
            "taxonomy_group": "",
            "desc": "Radiology, Vascular & Interventional Radiology",
            "state": "GU",
            "license": "M-1142",
            "primary": true
        },
        {
            "code": "208VP0014X",
            "taxonomy_group": "",
            "desc": "Pain Medicine, Interventional Pain Medicine",
            "state": "GU",
            "license": "M-1142",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Tamuning, GU

Sources for this page

Verify at the official NPI Registry.