NPIMap

Individual provider Active NPI

Jason B Bergman, MD

  • Family Medicine Physician
  • Independence, MO
National Provider Identifier
1326056722
Registry record updated May 18, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
2004016407 Issued in MO
Practice address
19550 E 39TH St S Ste 335
Independence, MO 64057-2311
Phone
(816) 350-0005
Fax
(816) 350-0015
NPI assigned
Aug 3, 2006
Last updated
May 18, 2022By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 18, 2022

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 2004016407 MO Primary

Addresses

Primary practice location

19550 E 39TH St S Ste 335
Independence, MO 64057-2311

Mailing address

19550 E 39TH St S Ste 335
Independence, MO 64057-2311
Phone (816) 350-0005

Other identifiers 3

IdentifierTypeStateIssuer
200418930AMedicaidKS
201468105MedicaidMO
P00373752OtherMORAILROAD

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address JASON.BERGMAN@hca2.eclinicaldirectplus.com

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MO
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20061024000308 MO Practitioner - Family Practice 1456358050 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
University of Missouri, Kansas City, School of Medicine, 2003
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Centerpoint Physicians Group LLCGroup PAC ID 7214020635, 5 clinicians

Practice addresses (Care Compare)

19550 E 39TH St S
335 Centerpoint Physicians
Independence, MO 64057-2311
Phone (816) 350-0005

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
2004016407MOMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Centerpoint Physicians Group LLC CurrentSince Jun 6, 2022 Accepting new patients

Locations

19550 E 39th St S
Ste 245
Independence, MO 64057
Phone (816) 373-0655

19550 E 39th St S
Ste 335
Independence, MO 64057
Phone (816) 350-0005

2000 Health Park Dr
Brentwood, TN 37027
Phone (615) 372-5426

Interoperability endpoints

  • Direct secure messaging: jason.bergman@hca2.eclinicaldirectplus.com

Organizations & group practices 1

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.

Hospital & facility affiliations 11

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": "1154563200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1652832000000",
    "number": "1326056722",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "19550 E 39TH ST S STE 335",
            "city": "INDEPENDENCE",
            "state": "MO",
            "postal_code": "640572311",
            "telephone_number": "816-350-0005",
            "fax_number": "816-350-0015"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "19550 E 39TH ST S STE 335",
            "city": "INDEPENDENCE",
            "state": "MO",
            "postal_code": "640572311",
            "telephone_number": "816-350-0005",
            "fax_number": "816-350-0015"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BERGMAN",
        "first_name": "JASON",
        "middle_name": "B",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-08-03",
        "last_updated": "2022-05-18",
        "certification_date": "2022-05-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "MO",
            "license": "2004016407",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "200418930A",
            "state": "KS"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "201468105",
            "state": "MO"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD",
            "identifier": "P00373752",
            "state": "MO"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "JASON.BERGMAN@hca2.eclinicaldirectplus.com",
            "affiliation": "N",
            "address_1": "19550 E 39th St S Ste 335",
            "city": "Independence",
            "state": "MO",
            "country_code": "US",
            "postal_code": "640572311",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Independence, MO

Sources for this page

Verify at the official NPI Registry.