Matthew Berg, BCBA

Primary specialty

Behavior AnalystTaxonomy code 103K00000X

License

1-22-59463

Practice address

1530 S Shields Dr
Waukegan, IL 60085-8307

Phone

(847) 731-5736

NPI assigned

Jun 18, 2019

Last updated

Jul 12, 2022By the provider in NPPES

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Practice roles

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.

• KGH Consultation & Treatment, Inc.

  dba KGH Autism Services

  • Behavior Analyst
  • Deerfield, IL
  • NPI 1073840740
  NPD (past)

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

{
    "created_epoch": "1560816000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1657584000000",
    "number": "1295395572",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1530 S SHIELDS DR",
            "city": "WAUKEGAN",
            "state": "IL",
            "postal_code": "600858307",
            "telephone_number": "847-731-5736"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1530 S SHIELDS DR",
            "city": "WAUKEGAN",
            "state": "IL",
            "postal_code": "600858307",
            "telephone_number": "847-731-5736"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BERG",
        "first_name": "MATTHEW",
        "credential": "BCBA",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2019-06-18",
        "last_updated": "2022-07-12",
        "certification_date": "2022-07-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103K00000X",
            "taxonomy_group": "",
            "desc": "Behavior Analyst",
            "state": null,
            "license": "1-22-59463",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BEHAVIOR ANALYST CERTIFICATION BOARD",
            "identifier": "1-22-59463",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Adalberto Beltran Perez, MSN, FNP-C
• Chloe Beltran, MA
• Nora Beltran, MD
• Robert Benassi
• Marisenda Benitez, DPM
• Katherine Bergstrom, MHP
• Solomon Yacob Berhanu
• Lovely Dawn Lustre Besario, PT
• Tatiana Jatrice Bey
• Beyond Wellness PLLC

• Behavior Analyst in Waukegan, IL
• Providers in Waukegan, IL by specialty
• Behavior Analyst in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 12, 2022; 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.