Active NPI
Bruce Jay Berwald, MD
- Internal Medicine Physician
- Bridgeton, MO
National Provider Identifier
1376647644
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Internal Medicine Physician
- License
- 114332
- Practice address
- 3478 Bridgeland Dr
Bridgeton, MO 63044-2619 - Phone
- (314) 739-8200
- Fax
- (314) 739-8261
- NPI assigned
- Sep 8, 2006
- Sex
- Male
- Sole proprietor
- No
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 |
|---|---|---|---|---|
| Internal Medicine Physician | 207R00000X | 114332 | MO | Primary |
Addresses
Primary practice location
3478 Bridgeland Dr
Bridgeton, MO 63044-2619
Mailing address
3478 Bridgeland Dr
Bridgeton, MO 63044-2639
Phone (314) 739-8200
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 205292204 | Medicaid | MO |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in MO
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: Yes
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20101103000503 | MO | Practitioner - Internal Medicine | 7810181849 | Reassigns benefits to 1 organization |
Care Compare profile
Medicare Care Compare- Specialty
- Internal Medicine
- Education
- Medical University of South Carolina College of Medicine, 1995
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- Elite Physical Therapy of Creve Coeur LLCBerwald Surgical Medical Inc
Practice addresses (Care Compare)
12788 Olive Blvd
Creve Coeur, MO 63141-6211
3478 Bridgeland Dr
Suite 2
Bridgeton, MO 63044-2619
Phone (314) 739-8200
Hospital & facility affiliations
- Delmar Gardens Home Care Inc
- SSM Health Depaul Hospital St Louis
- Mercy Hospital St Louis
- St Lukes Hospital
- Missouri Baptist Medical Center
- SSM Health Rehabilitation Hospital
Procedures performed for Medicare patients
| Procedure | Number of procedures |
|---|---|
| Removal of skin lesions | 1-10 |
| Removal or shaving of skin growth | 1-10 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Berwald Surgical Medical Inc | Current | Accepting new patients |
Locations
3478 Bridgeland Dr
Ste 2
Bridgeton, MO 63044
Phone (314) 739-8200
3478 Bridgeland Dr
Bridgeton, MO 63044
Phone (314) 291-2573
Interoperability endpoints
- bberwald3130@direct-ehr-ssmhc.com
- bruce_berwald_767971414@berwaldsurgicalmedical.amazing-direct.com
Organizations & group practices 2
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.
-
- Rehabilitation Clinic/Center
- Creve Coeur, MO
- NPI 1679947774
Hospital & facility affiliations 7
Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.
-
- Home Health Agency
- Chesterfield, MO
- NPI 1295720118
-
- General Acute Care Hospital
- Saint Louis, MO
- NPI 1427098169
Hospital
-
- Rehabilitation Hospital
- Richmond Heights, MO
- NPI 1659511988
Inpatient rehabilitation facility
-
- General Acute Care Hospital
- Chesterfield, MO
- NPI 1346251543
Hospital
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1157673600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1547510400000",
"number": "1376647644",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3478 BRIDGELAND DR",
"city": "BRIDGETON",
"state": "MO",
"postal_code": "630442639",
"telephone_number": "314-739-8200",
"fax_number": "314-735-4490"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3478 BRIDGELAND DR",
"city": "BRIDGETON",
"state": "MO",
"postal_code": "630442619",
"telephone_number": "314-739-8200",
"fax_number": "314-739-8261"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BERWALD",
"first_name": "BRUCE",
"middle_name": "JAY",
"name_prefix": "Dr.",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-09-08",
"last_updated": "2019-01-15",
"status": "A"
},
"taxonomies": [
{
"code": "207R00000X",
"taxonomy_group": "",
"desc": "Internal Medicine",
"state": "MO",
"license": "114332",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "205292204",
"state": "MO"
}
],
"endpoints": [],
"other_names": []
}Other providers in Bridgeton, MO
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 15, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.