Active NPI
Matthew Bergman
- Dentist
- Prescott Valley, AZ
National Provider Identifier
1366636540
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- D5843
- Practice address
- 8154 E Florentine Rd Ste B
Prescott Valley, AZ 86314-8487 - Phone
- (928) 772-8175
- NPI assigned
- Aug 30, 2007
- Last updated
- Aug 30, 2007
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | D5843 | AZ | Primary |
Addresses
Primary practice location
8154 E Florentine Rd Ste B
Prescott Valley, AZ 86314-8487
Mailing address
8154 E Florentine Rd Ste B
Prescott Valley, AZ 86314-8487
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| D5843 | AZ | MD | Dentist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Cranmer LLC | Past | Accepting new patients |
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.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1188432000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1188432000000",
"number": "1366636540",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "8154 E FLORENTINE RD STE B",
"city": "PRESCOTT VALLEY",
"state": "AZ",
"postal_code": "863148487"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "8154 E FLORENTINE RD STE B",
"city": "PRESCOTT VALLEY",
"state": "AZ",
"postal_code": "863148487",
"telephone_number": "928-772-8175"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BERGMAN",
"first_name": "MATTHEW",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2007-08-30",
"last_updated": "2007-08-30",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "AZ",
"license": "D5843",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Prescott Valley, AZ
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 30, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.