Individual provider Active NPI

Nicole Marie Bergman, OD

  • Optometrist
  • Bloomington, MN
National Provider Identifier
1275272593
Registry record updated Jun 3, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
3789 Issued in MN
Practice address
9801 Dupont Ave S Ste 425
Bloomington, MN 55431-3873
Phone
(952) 888-5800
Fax
(952) 567-6156
NPI assigned
Jun 3, 2022
Last updated
Jun 3, 2022By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 3, 2022

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Optometrist 152W00000X 3789 MN Primary

Addresses

Primary practice location

9801 Dupont Ave S Ste 425
Bloomington, MN 55431-3873

Mailing address

9801 Dupont Ave S Ste 425
Bloomington, MN 55431-3873
Phone (952) 567-6125

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MN
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: No
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20220616002302 MN Practitioner - Optometry 9638558968 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Optometry
Education
Illinois College of Optometry at Chicago, 2022
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Minnesota Eye Consultants, PAGroup PAC ID 4284524539, 34 clinicians

Practice addresses (Care Compare)

9801 Dupont Ave S
Suite 200
Bloomington, MN 55431-3200
Phone (952) 888-5800

Merit-based Incentive Payment System (MIPS)

Final score
80.11 of 100Reported as group
Quality
73.53
Promoting interoperability
100
Improvement activities
40
Cost
60.18

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

Practice roles

OrganizationSpecialtyStatusNew patients
Minnesota Eye Consultants, PA CurrentSince Jul 1, 2022 Accepting new patients
Northwest Eye Clinic, LLC Past Accepting new patients
Minnesota Eye Consultants, PA Past Accepting new patients

Locations

11091 Ulysses St NE
Ste 300
Blaine, MN 55434
Phone (763) 421-9410

9801 DuPont Ave S
Ste 200
Minneapolis, MN 55431

9801 DuPont Ave S
Ste 425
Minneapolis, MN 55431
Phone (952) 567-6092

Interoperability endpoints

  • Direct secure messaging: nbergman@uvpmec.intellechartdirect.net

Organizations & group practices 3

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.

NPI Registry JSON

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

{
    "created_epoch": "1654214400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1654214400000",
    "number": "1275272593",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9801 DUPONT AVE S STE 425",
            "city": "BLOOMINGTON",
            "state": "MN",
            "postal_code": "554313873",
            "telephone_number": "952-567-6125",
            "fax_number": "952-567-6176"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9801 DUPONT AVE S STE 425",
            "city": "BLOOMINGTON",
            "state": "MN",
            "postal_code": "554313873",
            "telephone_number": "952-888-5800",
            "fax_number": "952-567-6156"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BERGMAN",
        "first_name": "NICOLE",
        "middle_name": "MARIE",
        "credential": "OD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2022-06-03",
        "last_updated": "2022-06-03",
        "certification_date": "2022-05-31",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "MN",
            "license": "3789",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Bloomington, MN

Sources for this page

Verify at the official NPI Registry.