NPIMap

Organization Active NPI

Randall P Bergen DPM PC

  • Podiatric Clinic/Center
  • Sioux City, IA
National Provider Identifier
1285891432
Registry record updated May 16, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Podiatric Clinic/CenterTaxonomy code 261QP1100X
Legal business name
RANDALL P BERGEN DPM PC
Practice address
505 5TH St
Suite 714
Sioux City, IA 51101-1500
Phone
(712) 255-3526
Fax
(712) 255-0298
NPI assigned
May 16, 2008
Last updated
May 16, 2008By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 16, 2008

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

Authorized official

Name
Randall Paul Bergen, DPMNPI 1861466583
Title
President Physician
Phone
(712) 255-3526

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Podiatric Clinic/Center 261QP1100X Primary

Addresses

Primary practice location

505 5TH St
Suite 714
Sioux City, IA 51101-1500

Mailing address

505 5TH St
Suite 714
Sioux City, IA 51101-1500
Phone (712) 255-3526

Other identifiers 3

IdentifierTypeStateIssuer
0091108MedicaidIA
09110OtherIAWELLMARK BCBS
480007118OtherIARAILROAD MEDICARE

National Provider Directory

National Provider Directory

Locations

2815 Lincoln Way
Sioux City, IA 51106
Phone (712) 274-2252

505 5th St
Ste 714
Sioux City, IA 51101
Phone (712) 255-3526

702 Cedar Ave
Laurel, NE 68745
Phone (402) 256-2961

Practitioners & affiliated clinicians

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1210896000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1210896000000",
    "number": "1285891432",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "505 5TH ST",
            "address_2": "SUITE 714",
            "city": "SIOUX CITY",
            "state": "IA",
            "postal_code": "511011500",
            "telephone_number": "712-255-3526",
            "fax_number": "712-255-0298"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "505 5TH ST",
            "address_2": "SUITE 714",
            "city": "SIOUX CITY",
            "state": "IA",
            "postal_code": "511011500",
            "telephone_number": "712-255-3526",
            "fax_number": "712-255-0298"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "RANDALL P BERGEN DPM PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-05-16",
        "last_updated": "2008-05-16",
        "status": "A",
        "authorized_official_last_name": "BERGEN",
        "authorized_official_first_name": "RANDALL",
        "authorized_official_middle_name": "PAUL",
        "authorized_official_title_or_position": "PRESIDENT PHYSICIAN",
        "authorized_official_telephone_number": "712-255-3526",
        "authorized_official_credential": "DPM"
    },
    "taxonomies": [
        {
            "code": "261QP1100X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Podiatric",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0091108",
            "state": "IA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "WELLMARK BCBS",
            "identifier": "09110",
            "state": "IA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "480007118",
            "state": "IA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Sioux City, IA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 16, 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.