Individual provider Active NPI

Andrew Schutz Bernhardson, M.D.

  • Orthopaedic Surgery Physician
  • Jacksonville, FL
National Provider Identifier
1396056578
Registry record updated Jun 21, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Orthopaedic Surgery PhysicianTaxonomy code 207X00000X
License
54352 Issued in MN
Practice address
2005 Knight Lane BLDG H
Navy Medicine Support Command, Medical Staff Services
Jacksonville, FL 32212-0140
Phone
(619) 532-6400
NPI assigned
Jun 23, 2010
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 21, 2021

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Student in an Organized Health Care Education/Training Program 390200000X
Orthopaedic Surgery Physician 207X00000X 54352 MN Primary

Addresses

Primary practice location

2005 Knight Lane BLDG H
Navy Medicine Support Command, Medical Staff Services
Jacksonville, FL 32212-0140

Mailing address

3001 Green Bay Rd
North Chicago, IL 60064-3048
Phone (612) 382-1616

Other practice location 1

3001 Green Bay Rd
North Chicago, IL 60064-3048
Phone (612) 382-1616

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
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
54352MNMDOrthopaedic Surgery Physician

NPI Registry JSON

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

{
    "created_epoch": "1277251200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1624233600000",
    "number": "1396056578",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3001 GREEN BAY RD",
            "city": "NORTH CHICAGO",
            "state": "IL",
            "postal_code": "600643048",
            "telephone_number": "612-382-1616"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2005 KNIGHT LANE BLDG H",
            "address_2": "NAVY MEDICINE SUPPORT COMMAND, MEDICAL STAFF SERVICES",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322120140",
            "telephone_number": "619-532-6400"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "3001 Green Bay Rd",
            "address_purpose": "LOCATION",
            "city": "North Chicago",
            "state": "IL",
            "postal_code": "600643048",
            "country_code": "US",
            "telephone_number": "612-382-1616",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "BERNHARDSON",
        "first_name": "ANDREW",
        "middle_name": "SCHUTZ",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2010-06-23",
        "last_updated": "2021-06-21",
        "certification_date": "2021-06-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207X00000X",
            "taxonomy_group": "",
            "desc": "Orthopaedic Surgery",
            "state": "MN",
            "license": "54352",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Jacksonville, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 21, 2021; 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.