NPIMap

Individual provider Active NPI

Mery Josefina Cortes-Bergoderi, M.D.

  • Internal Medicine Physician
  • Laredo, TX
National Provider Identifier
1336570902
Registry record updated Dec 3, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
Q0424 Issued in TX
Practice address
1515 Pappas St
Laredo, TX 78041-1705
Phone
(956) 795-8100
Fax
(956) 718-6294
NPI assigned
Dec 9, 2013
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 3, 2015

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X Q0424 TX Primary

Addresses

Primary practice location

1515 Pappas St
Laredo, TX 78041-1705

Mailing address

1515 Pappas St
Laredo, TX 78041-1705
Phone (956) 795-8100

Other identifiers 2

IdentifierTypeStateIssuer
339013001MedicaidTX
Q0424OtherTXLICENSE

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TX
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
I20140919001113 TX Practitioner - Internal Medicine 6507085735 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Internal Medicine
Education
Other, 2006
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Gateway Community Health Center IncGroup PAC ID 0941193510, 22 clinicians

Practice addresses (Care Compare)

1515 Pappas St
Laredo, TX 78041-1705
Phone (956) 795-8100

Hospital & facility affiliations

  • Pro Health Nursing Inc Home health agency, Laredo, TX, CCN 677899
  • Healing Hands Home Health Care LLC Home health agency, Laredo, TX, CCN 679502
  • Laredo Medical Center Hospital, Laredo, TX, CCN 450029
  • Doctors Hospital of Laredo Hospital, Laredo, TX, CCN 450643

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
Q0424TXMDInternal Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Gateway Community Health Center, Inc CurrentSince Aug 11, 2014 Accepting new patients
Gateway Community Health Center, Inc Current Accepting new patients
Gateway Community Health Center, Inc. CurrentSince Aug 11, 2014 Accepting new patients
Gateway Community Health Center, Inc. Past Accepting new patients

Locations

1515 Pappas St
Laredo, TX 78041
Phone (956) 523-3642

Interoperability endpoints

  • Direct secure messaging: south@gchc.directbygreenway.com

Ownership & related parties

All facility ownership & control disclosures 5

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
Gateway Community Health Center IncHebbronville, TX, CCN 671917 Federally qualified health center Corporate Officer
Corporate Director		 Dec 20, 2014
Dec 20, 2014
Gateway Community Health Center IncLaredo, TX, CCN 451841 Federally qualified health center Corporate Officer
W-2 Managing Employee		 Dec 20, 2014
Dec 20, 2014
Gateway Community Health Center IncLaredo, TX, CCN 451097 Federally qualified health center Corporate Officer
W-2 Managing Employee		 Dec 20, 2014
Dec 20, 2014
GCHC - Dr. GarzaLaredo, TX, CCN 671166 Federally qualified health center Corporate Officer
Corporate Director
W-2 Managing Employee		 Dec 20, 2014
Dec 20, 2014
Dec 20, 2014
GCHC - Dr. MartinezLaredo, TX, CCN 671146 Federally qualified health center Corporate Officer
W-2 Managing Employee		 Dec 20, 2014
Dec 20, 2014

Owned or controlled facilities with NPI records 5

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

Organizations & group practices 4

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 4

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": "1386547200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1449100800000",
    "number": "1336570902",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1515 PAPPAS ST",
            "city": "LAREDO",
            "state": "TX",
            "postal_code": "780411705",
            "telephone_number": "956-795-8100",
            "fax_number": "956-718-6294"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1515 PAPPAS ST",
            "city": "LAREDO",
            "state": "TX",
            "postal_code": "780411705",
            "telephone_number": "956-795-8100",
            "fax_number": "956-718-6294"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CORTES-BERGODERI",
        "first_name": "MERY",
        "middle_name": "JOSEFINA",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2013-12-09",
        "last_updated": "2015-12-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "TX",
            "license": "Q0424",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "339013001",
            "state": "TX"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "LICENSE",
            "identifier": "Q0424",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Laredo, TX

Sources for this page

Verify at the official NPI Registry.