Active NPI
Kailey Cheryl Berg, CRM, PSS
- Peer Specialist
- Bend, OR
National Provider Identifier
1295410447
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Peer Specialist
- License
- 22-CRM-1049
- Practice address
- 908 NE 4TH St
Bend, OR 97701-4646 - Phone
- (541) 460-8237
- NPI assigned
- Jun 15, 2023
- Last updated
- Jun 15, 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 |
|---|---|---|---|---|
| Peer Specialist | 175T00000X | 22-CRM-1049 | OR | Primary |
Addresses
Primary practice location
908 NE 4TH St
Bend, OR 97701-4646
Mailing address
908 NE 4TH St Ste 204
Bend, OR 97701-4646
Phone (541) 460-8237
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 |
|---|---|---|---|
| 22-CRM-1049 | OR | MD | Peer Specialist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1686787200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1686787200000",
"number": "1295410447",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "908 NE 4TH ST STE 204",
"city": "BEND",
"state": "OR",
"postal_code": "977014646",
"telephone_number": "541-460-8237"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "908 NE 4TH ST",
"city": "BEND",
"state": "OR",
"postal_code": "977014646",
"telephone_number": "541-460-8237"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BERG",
"first_name": "KAILEY",
"middle_name": "CHERYL",
"credential": "CRM, PSS",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2023-06-15",
"last_updated": "2023-06-15",
"certification_date": "2023-06-13",
"status": "A"
},
"taxonomies": [
{
"code": "175T00000X",
"taxonomy_group": "",
"desc": "Peer Specialist",
"state": "OR",
"license": "22-CRM-1049",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Bend, OR
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 15, 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.