Jack Alton Bergh, MD

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

ME0056971 Issued in FL

Practice address

1539 Dale Mabry Hwy Ste 102
Lutz, FL 33548

Phone

(813) 909-7102

Fax

(813) 909-0199

NPI assigned

Apr 10, 2006

Last updated

Jan 8, 2013By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Interoperability endpoints

• Direct secure messaging: jack.bergh@wellmed.eclinicaldirectplus.com

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.

• Myrtle Ridge Family Medicine, PA

  • Family Medicine Physician
  • Lutz, FL
  • NPI 1427195809
  Authorized official Same address or phone

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

{
    "created_epoch": "1144627200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1357603200000",
    "number": "1376506394",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "14743 MORNING DR",
            "city": "LUTZ",
            "state": "FL",
            "postal_code": "335593257",
            "telephone_number": "813-975-4743"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1539 DALE MABRY HWY STE 102",
            "city": "LUTZ",
            "state": "FL",
            "postal_code": "33548",
            "telephone_number": "813-909-7102",
            "fax_number": "813-909-0199"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BERGH",
        "first_name": "JACK",
        "middle_name": "ALTON",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-04-10",
        "last_updated": "2013-01-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "FL",
            "license": "ME0056971",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "770008300",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Melissa Benitez
• Lisa Marie Bentivenga, LCSW
• Aleishla Taina Beras
• Gloria Nadayil Berchmans
• Melanie Charlene Berger
• Melanie Bermudez
• Sandra Bermudez
• Brett Berner, D.C.
• Ashley N Berrazueta
• Ramy Beshai

• Family Medicine Physician in Lutz, FL
• Providers in Lutz, FL by specialty
• Family Medicine Physician in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 8, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.