NPIMap

Organization Active NPI

Robert G Berry Jr LTD

  • Physical Medicine & Rehabilitation Physician
  • Reno, NV
National Provider Identifier
1386654911
Registry record updated Jul 10, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical Medicine & Rehabilitation PhysicianTaxonomy code 208100000X
Legal business name
ROBERT G BERRY JR LTD
Practice address
6630 S McCarran Blvd Ste A3
Reno, NV 89509-6184
Phone
(775) 828-2863
Fax
(866) 571-0056
NPI assigned
Aug 8, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 10, 2023

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

Authorized official

Name
Ashley B Georgetta
Title
Credentialing
Phone
(775) 448-9456

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Medicine & Rehabilitation PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 208100000X NV Primary
Physical Medicine & Rehabilitation PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 208100000X

Addresses

Primary practice location

6630 S McCarran Blvd Ste A3
Reno, NV 89509-6184

Mailing address

6630 S McCarran Blvd Ste A3
Reno, NV 89509-6136
Phone (775) 828-2863

Other names 2

  • Mountain West Sport and Spine Doing business as
  • Orthopedic Rehabilitation Specialist of Nevada Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20050715000141 NV Part B Supplier - Clinic/Group Practice 2466488903 Receives reassigned benefits from 7 practitioners
Practice locations: Reno, NV

National Provider Directory

National Provider Directory

Locations

103 Fair Dr
Susanville, CA 96130
Phone (530) 257-7772

475 8th St
Elko, NV 89801
Phone (775) 777-1510

6630 S McCarran Blvd
Ste 4
Reno, NV 89509
Phone (775) 828-2873

255 Glendale Ave
Ste 15
Sparks, NV 89431
Phone (702) 356-8181

Practitioners & affiliated clinicians

Practitioners 9

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1154995200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1688947200000",
    "number": "1386654911",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6630 S MCCARRAN BLVD STE A3",
            "city": "RENO",
            "state": "NV",
            "postal_code": "895096136",
            "telephone_number": "775-828-2863",
            "fax_number": "775-448-9447"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6630 S MCCARRAN BLVD STE A3",
            "city": "RENO",
            "state": "NV",
            "postal_code": "895096184",
            "telephone_number": "775-828-2863",
            "fax_number": "866-571-0056"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ROBERT G BERRY JR LTD",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-08-08",
        "last_updated": "2023-07-10",
        "certification_date": "2023-07-10",
        "status": "A",
        "authorized_official_last_name": "GEORGETTA",
        "authorized_official_first_name": "ASHLEY",
        "authorized_official_middle_name": "B",
        "authorized_official_title_or_position": "CREDENTIALING",
        "authorized_official_telephone_number": "775-448-9456"
    },
    "taxonomies": [
        {
            "code": "208100000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Physical Medicine & Rehabilitation",
            "state": "NV",
            "license": null,
            "primary": true
        },
        {
            "code": "208100000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Physical Medicine & Rehabilitation",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Mountain West Sport and Spine",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Orthopedic Rehabilitation Specialist of Nevada",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Orthopedic Rehabilitation Specialist of Nevada",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Reno, NV

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 10, 2023; 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.