Active NPI
Jacqueline Berg
- Massage Therapist
- Seattle, WA
National Provider Identifier
1275219206
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Massage Therapist
- License
- MA61455883
- Practice address
- 9709 3Rd Ave NE Ste 103
Seattle, WA 98115-2027 - Phone
- (206) 527-9709
- Fax
- (206) 526-2991
- NPI assigned
- Jun 26, 2023
- Sex
- Female
- 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 |
|---|---|---|---|---|
| Massage Therapist | 225700000X | MA61455883 | WA | Primary |
Addresses
Primary practice location
9709 3Rd Ave NE Ste 103
Seattle, WA 98115-2027
Mailing address
9515 Interlake Ave N Apt 306
Seattle, WA 98103-3360
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
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| MA61455883 | WA | MD | Massage Therapist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Green Lake Massage Health Center, LLC | Massage Therapist | Past | Accepting new patients |
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.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1687737600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1687737600000",
"number": "1275219206",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "9515 INTERLAKE AVE N APT 306",
"city": "SEATTLE",
"state": "WA",
"postal_code": "981033360"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "9709 3RD AVE NE STE 103",
"city": "SEATTLE",
"state": "WA",
"postal_code": "981152027",
"telephone_number": "206-527-9709",
"fax_number": "206-526-2991"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BERG",
"first_name": "JACQUELINE",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2023-06-26",
"last_updated": "2023-06-26",
"certification_date": "2023-06-24",
"status": "A"
},
"taxonomies": [
{
"code": "225700000X",
"taxonomy_group": "",
"desc": "Massage Therapist",
"state": "WA",
"license": "MA61455883",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Seattle, WA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 26, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.