Individual provider Active NPI

Bergen Iris Kassoff, PA-C

  • Physician Assistant
  • Washington, DC
National Provider Identifier
1295420875
Registry record updated Apr 19, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
PA200001820 Issued in DC
Practice address
106 Irving St NW Ste 216
Washington, DC 20010-2993
Phone
(301) 742-6051
NPI assigned
Apr 10, 2023
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 19, 2024

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X C0009332 MD
Physician Assistant 363A00000X PA200001820 DC Primary

Addresses

Primary practice location

106 Irving St NW Ste 216
Washington, DC 20010-2993

Mailing address

106 Irving St NW Ste 216
Washington, DC 20010-2993
Phone (301) 742-6051

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20240513003490 DC Practitioner - Physician Assistant 5799126439 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2023
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Medstar Medical Group II LLCGroup PAC ID 0547413825, 3,726 clinicians

Practice addresses (Care Compare)

1145 19TH St NW
311 MMG at 19TH Street NW
Washington, DC 20036-3735
Phone (202) 429-2401

12158 Central Ave
Mitchellville, MD 20721-1932
Phone (301) 430-2750

Hospital & facility affiliations

  • Medstar Washington Hospital Center Hospital, Washington, DC, CCN 090011

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

State licenses

LicenseStateTypeSpecialty
PA200001820DCMDPhysician Assistant
C0009332MDMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Medstar Medical Group II LLC CurrentSince Apr 1, 2024 Accepting new patients

Locations

3007 Tilden St NW
Ste 5N
Washington, DC 20008

106 Irving St NW
Ste 216
Washington, DC 20010
Phone (202) 877-5840

1145 19th St NW
Ste 311
Washington, DC 20036
Phone (202) 429-2401

Organizations & group practices 2

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.

Hospital & facility affiliations 1

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1681084800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1713484800000",
    "number": "1295420875",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "106 IRVING ST NW STE 216",
            "city": "WASHINGTON",
            "state": "DC",
            "postal_code": "200102993",
            "telephone_number": "301-742-6051"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "106 IRVING ST NW STE 216",
            "city": "WASHINGTON",
            "state": "DC",
            "postal_code": "200102993",
            "telephone_number": "301-742-6051"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KASSOFF",
        "first_name": "BERGEN",
        "middle_name": "IRIS",
        "name_prefix": "Mrs.",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2023-04-10",
        "last_updated": "2024-04-19",
        "certification_date": "2024-04-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "MD",
            "license": "C0009332",
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "DC",
            "license": "PA200001820",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Washington, DC

Sources for this page

Verify at the official NPI Registry.