Samuel Avon Bern, M.D.

Primary specialty

Plastic Surgery PhysicianTaxonomy code 208200000X

License

G60603 Issued in CA

Practice address

1280 S Victoria Ave
Suite 201
Ventura, CA 93003-6555

Phone

(805) 642-1699

Fax

(805) 642-1919

NPI assigned

Mar 31, 2006

Last updated

Jul 8, 2007By 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

Enrolled in CA

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

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

{
    "created_epoch": "1143763200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1306807862",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1280 S VICTORIA AVE",
            "address_2": "SUITE 201",
            "city": "VENTURA",
            "state": "CA",
            "postal_code": "930036555",
            "telephone_number": "805-642-1699",
            "fax_number": "805-642-1919"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1280 S VICTORIA AVE",
            "address_2": "SUITE 201",
            "city": "VENTURA",
            "state": "CA",
            "postal_code": "930036555",
            "telephone_number": "805-642-1699",
            "fax_number": "805-642-1919"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BERN",
        "first_name": "SAMUEL",
        "middle_name": "AVON",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-03-31",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208200000X",
            "taxonomy_group": "",
            "desc": "Plastic Surgery",
            "state": "CA",
            "license": "G60603",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "9078425",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Diane Berger, RN
• Kelsey Bergh
• Michael Warren Bergin, M.D.
• Robert Anton Berkovitz, D.C.
• Megan Paige Berman
• Elisa Bernal, AMFT
• Joseph Zacarias Bernal, SLPA
• Mariah Bernal
• Sandra Alicia Bernedo, PT, DPT
• Bernita Brazier (Just Being Healthy)

• Plastic Surgery Physician in Ventura, CA
• Providers in Ventura, CA by specialty
• Plastic Surgery Physician in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.