Individual provider Active NPI

Kevin Berg, MD

  • Surgery Physician
  • Longmont, CO
National Provider Identifier
1396749792
Registry record updated Dec 5, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Surgery PhysicianTaxonomy code 208600000X
License
26055 Issued in CO
Practice address
1925 W Mountain View Ave
Longmont, CO 80501-3128
Phone
(303) 776-1234
Fax
(720) 494-3107
NPI assigned
Jun 13, 2005
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 5, 2014

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Surgery Physician 208600000X 26055 CO Primary

Addresses

Primary practice location

1925 W Mountain View Ave
Longmont, CO 80501-3128

Mailing address

1925 W Mountain View Ave
Longmont, CO 80501-3128
Phone (303) 776-1234

Other identifiers 1

IdentifierTypeStateIssuer
01260553MedicaidCO

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file
Eligible to order & refer
  • Part B services: No
  • Medical equipment: Yes
  • Home health: No
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
26055COMDSurgery Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Poudre Valley Medical Group, LLC CurrentSince Jan 1, 2015 Accepting new patients
Poudre Valley Medical Group, LLC Surgery Current Accepting new patients

Locations

340 E 1st Ave
Ste 101
Broomfield, CO 80020
Phone (303) 544-3800

4404 Barranca Ln
Castle Rock, CO 80104
Phone (720) 733-5260

8890 N Union Blvd
Colorado Springs, CO 80920
Phone (719) 364-5633

6600 Firestone Blvd
Firestone, CO 80504
Phone (303) 649-3450

1760 E Ken Pratt Blvd
Ste 205
Longmont, CO 80504
Phone (720) 718-3930

1750 E Ken Pratt Blvd
Fl 3
Longmont, CO 80504
Phone (720) 718-3900

1925 Mountain View Ave
Longmont, CO 80501
Phone (303) 776-1234

2695 Rocky Mountain Ave
Ste 150
Loveland, CO 80538
Phone (970) 624-2412

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.

NPI Registry JSON

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

{
    "created_epoch": "1118620800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1417737600000",
    "number": "1396749792",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1925 W MOUNTAIN VIEW AVE",
            "city": "LONGMONT",
            "state": "CO",
            "postal_code": "805013128",
            "telephone_number": "303-776-1234",
            "fax_number": "720-494-3107"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1925 W MOUNTAIN VIEW AVE",
            "city": "LONGMONT",
            "state": "CO",
            "postal_code": "805013128",
            "telephone_number": "303-776-1234",
            "fax_number": "720-494-3107"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BERG",
        "first_name": "KEVIN",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-06-13",
        "last_updated": "2014-12-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208600000X",
            "taxonomy_group": "",
            "desc": "Surgery",
            "state": "CO",
            "license": "26055",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "01260553",
            "state": "CO"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Longmont, CO

Sources for this page

Verify at the official NPI Registry.