Active NPI
Richard Bergman, LSW
- Social Worker
- Montpelier, ID
National Provider Identifier
1386767465
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Social Worker
- License
- LSW-26240
- Practice address
- 164 S 5TH St
Montpelier, ID 83254-1557 - Phone
- (208) 847-4464
- Fax
- (208) 847-0980
- NPI assigned
- Apr 6, 2007
- Last updated
- Jul 9, 2007
- 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 |
|---|---|---|---|---|
| Social Worker | 104100000X | LSW-26240 | ID | Primary |
Addresses
Primary practice location
164 S 5TH St
Montpelier, ID 83254-1557
Mailing address
971 McKinley Ave
Pocatello, ID 83201-4922
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 |
|---|---|---|---|
| LSW-26240 | ID | MD | Social Worker |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1175817600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183939200000",
"number": "1386767465",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "971 MCKINLEY AVE",
"city": "POCATELLO",
"state": "ID",
"postal_code": "832014922"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "164 S 5TH ST",
"city": "MONTPELIER",
"state": "ID",
"postal_code": "832541557",
"telephone_number": "208-847-4464",
"fax_number": "208-847-0980"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BERGMAN",
"first_name": "RICHARD",
"credential": "LSW",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2007-04-06",
"last_updated": "2007-07-09",
"status": "A"
},
"taxonomies": [
{
"code": "104100000X",
"taxonomy_group": "",
"desc": "Social Worker",
"state": "ID",
"license": "LSW-26240",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Montpelier, ID
- Bear Lake Dental Care, PLLC
- Bear Lake Drug LLC
- Bear Lake Memorial Hospital
- Bear Lake Memorial Hospital (Bear Lake Manor)
- Bear Lake Physical and Sports Therapy PC
- Mark Berning, PHARMD
- Laurie Bingham
- BLMH Mental Health (Bear Lake Memorial Hospital Mental Health)
- Larry David Bomsta, MD
- Joshua Seth Bowman, DC
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 9, 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.