Amy J Bergh, LSW – Case Manager/Care Coordinator

Key facts

NPI: 1295882264
Entity type: Individual (NPI type 1)
Primary specialty: Case Manager/Care Coordinator 171M00000X
Practice address: 2624 9TH Ave S
Fargo, ND 58103-2350
Phone: (701) 298-4500
Fax: (701) 298-4400
NPI assigned: Jan 4, 2007
Sex: Female
Sole proprietor: No

Medicare participation

Medicare fee-for-service enrollment: Not listed in the public Medicare enrollment file

National Provider Directory

Medicare enrollment (NPD): No

State licenses

License	State	Type	Specialty
13676	MN	MD	Physician Assistant

Specialties & licenses

Specialty (taxonomy)	Code	License	State	Primary
Social Worker	104100000X	13676	MN
Other Technician	247200000X
Case Manager/Care Coordinator	171M00000X			Yes

Addresses

Primary practice location

2624 9TH Ave S
Fargo, ND 58103-2350

Mailing address

2624 9TH Ave S
Fargo, ND 58103-2350
Phone (701) 298-4500

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API JSON format, last updated by the provider on Aug 26, 2020.

{
    "created_epoch": "1167868800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1598400000000",
    "number": "1295882264",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2624 9TH AVE S",
            "city": "FARGO",
            "state": "ND",
            "postal_code": "581032350",
            "telephone_number": "701-298-4500",
            "fax_number": "701-298-4400"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2624 9TH AVE S",
            "city": "FARGO",
            "state": "ND",
            "postal_code": "581032350",
            "telephone_number": "701-298-4500",
            "fax_number": "701-298-4400"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BERGH",
        "first_name": "AMY",
        "middle_name": "J",
        "name_prefix": "Mrs.",
        "credential": "LSW",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-01-04",
        "last_updated": "2020-08-26",
        "certification_date": "2020-08-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "104100000X",
            "taxonomy_group": "",
            "desc": "Social Worker",
            "state": "MN",
            "license": "13676",
            "primary": false
        },
        {
            "code": "247200000X",
            "taxonomy_group": "",
            "desc": "Technician, Other",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "171M00000X",
            "taxonomy_group": "",
            "desc": "Case Manager/Care Coordinator",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Fargo, ND

All providers in Fargo, ND · Case Manager/Care Coordinator in North Dakota

Sources for this page

NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Aug 26, 2020. Information in NPPES is self-reported and not verified by CMS.
NUCC Health Care Provider Taxonomy: specialty names.
National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.