NPIMap

Organization Active NPI

Bergdale & Hall, LLC

  • Child & Adolescent Psychiatry Physician
  • Las Vegas, NV
National Provider Identifier
1346609203
Registry record updated Sep 30, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Child & Adolescent Psychiatry PhysicianTaxonomy code 2084P0804X
License
NV20101014236 Issued in NV
Legal business name
BERGDALE & HALL, LLC
Practice address
6879 W Charleston Blvd
Suite a
Las Vegas, NV 89117-1672
Phone
(702) 376-0024
Fax
(702) 479-7173
NPI assigned
Feb 19, 2016
Last updated
Sep 30, 2016By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 30, 2016

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

Authorized official

Name
Sara Ann Hall, LCSW
Title
Owner
Phone
(702) 308-4807

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Child & Adolescent Psychiatry PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 2084P0804X NV20101014236 NV Primary

Addresses

Primary practice location

6879 W Charleston Blvd
Suite a
Las Vegas, NV 89117-1672

Mailing address

6879 W Charleston Blvd
Suite a
Las Vegas, NV 89117-1672
Phone (702) 376-0024

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NV

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20161024001598 NV Part B Supplier - Clinic/Group Practice 5698076602 Receives reassigned benefits from 10 practitioners
1 other NPI on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Las Vegas, NV

Other NPIs on the same Medicare enrollment 1

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

National Provider Directory

National Provider Directory
Tax ID family
Bergdale Hall LLC3 organizations share this tax ID, including this one

Other organizations with this tax ID 2

Organizations that report the same tax identification number in the National Provider Directory.

Member organizations 1

Organizations listed as members of this organization in the National Provider Directory.

Ownership & related parties

Subparts reporting this organization as parent 1

Organizations that report themselves as subparts in NPPES and name this organization, in the same state, as their parent.

Practitioners & affiliated clinicians

Practitioners 21

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 21

NPI Registry JSON

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

{
    "created_epoch": "1455840000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1475193600000",
    "number": "1346609203",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6879 W CHARLESTON BLVD",
            "address_2": "SUITE A",
            "city": "LAS VEGAS",
            "state": "NV",
            "postal_code": "891171672",
            "telephone_number": "702-376-0024",
            "fax_number": "702-479-7173"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6879 W CHARLESTON BLVD",
            "address_2": "SUITE A",
            "city": "LAS VEGAS",
            "state": "NV",
            "postal_code": "891171672",
            "telephone_number": "702-376-0024",
            "fax_number": "702-479-7173"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BERGDALE & HALL, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-02-19",
        "last_updated": "2016-09-30",
        "status": "A",
        "authorized_official_last_name": "HALL",
        "authorized_official_first_name": "SARA",
        "authorized_official_middle_name": "ANN",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "702-308-4807",
        "authorized_official_credential": "LCSW"
    },
    "taxonomies": [
        {
            "code": "2084P0804X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychiatry & Neurology, Child & Adolescent Psychiatry",
            "state": "NV",
            "license": "NV20101014236",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Las Vegas, NV

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 30, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.