Individual provider Active NPI

Michael Bergen, MD

  • Vascular & Interventional Radiology Physician
  • Cleveland, OH
National Provider Identifier
1407116718
Registry record updated Jan 17, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Vascular & Interventional Radiology PhysicianTaxonomy code 2085R0204X
License
35.146771 Issued in OH
Practice address
9500 Euclid Ave
Cleveland, OH 44195-1838
Phone
(216) 444-0617
Fax
(216) 445-1492
NPI assigned
May 21, 2012
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 17, 2023

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

Specialties & licenses 5

Specialty (taxonomy)CodeLicenseStatePrimary
Diagnostic Radiology Physician 2085R0202X 0101267361 VA
Vascular & Interventional Radiology Physician 2085R0204X 0101267361 VA
General Practice Physician 208D00000X 2756654 NY
Student in an Organized Health Care Education/Training Program 390200000X NY
Vascular & Interventional Radiology Physician 2085R0204X 35.146771 OH Primary

Addresses

Primary practice location

9500 Euclid Ave
Cleveland, OH 44195-1838

Mailing address

9500 Euclid Ave
Cleveland, OH 44195-0001
Phone (216) 444-6640

Other practice location 1

1906 Belleview Ave SE
Roanoke, VA 24014-1838
Phone (540) 981-7000

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address PROSZEM@ccf.org

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in VA, OH2 enrollments
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20190924000108 VA Practitioner - Interventional Radiology 0941568604 Reassigns benefits to 5 organizations
I20230130002115 OH Practitioner - Diagnostic RadiologyPractitioner - Interventional Radiology 0941568604 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Diagnostic Radiology
Education
Other, 2011
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Wooster Clinic LLCGroup PAC ID 6800708124, 290 clinicians
Cleveland ClinicGroup PAC ID 1850203555, 6,954 clinicians

Practice addresses (Care Compare)

1740 Cleveland Rd
Wooster, OH 44691-2204
Phone (330) 287-4500

9500 Euclid Ave
Cleveland, OH 44195-0001
Phone (216) 444-5433

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
0101267361VAMDVascular & Interventional Radiology Physician
2756654NYMDGeneral Practice Physician

Practice roles

OrganizationSpecialtyStatusNew patients
The Cleveland Clinic Foundation CurrentSince Dec 14, 2022 Accepting new patients
Clinic Medical Services Company LLC Diagnostic Radiology CurrentSince Feb 2, 2023 Accepting new patients
Carilion Medical Center CurrentSince Sep 9, 2019 Accepting new patients
Carilion Healthcare Corporation CurrentSince Sep 9, 2019 Accepting new patients
Carilion Giles Community Hospital CurrentSince Jan 1, 2020 Accepting new patients
Carilion Healthcare Corporation CurrentSince Sep 9, 2019 Accepting new patients
Wooster Clinic, LLC CurrentSince Dec 14, 2022 Accepting new patients
Carilion Giles Community Hospital CurrentSince Jan 1, 2020 Accepting new patients
Carilion Rockbridge Community Hospital CurrentSince Jan 1, 2020 Accepting new patients
Clinic Medical Services Company Diagnostic Radiology CurrentSince Feb 2, 2023 Accepting new patients
Carilion Tazewell Community Hospital CurrentSince Sep 9, 2019 Accepting new patients
Carilion Medical Center CurrentSince Sep 9, 2019 Accepting new patients
Carilion Rockbridge Community Hospital CurrentSince Jan 1, 2020 Accepting new patients
Carilion Giles Community Hospital Current Accepting new patients

Locations

2420 Lake Ave
Ashtabula, OH 44004
Phone (216) 986-2919

9500 Euclid Ave
Cleveland, OH 44195
Phone (216) 442-1270

6100 W Creek Rd
Ste 35
Independence, OH 44131
Phone (212) 986-1666

1740 Cleveland Rd
Wooster, OH 44691
Phone (330) 287-4500

1 Health Cir
Lexington, VA 24450
Phone (540) 458-3300

159 Hartley Way
Pearisburg, VA 24134
Phone (540) 921-6000

6415 Peters Creek Rd
Roanoke, VA 24019
Phone (703) 562-2110

1906 Belleview Ave SE
Roanoke, VA 24014
Phone (540) 853-0222

213 S Jefferson St
Ste 1006
Roanoke, VA 24011
Phone (540) 224-5353

2017 Jefferson St SW
Roanoke, VA 24014
Phone (540) 981-7128

388 Ben Bolt Ave
Tazewell, VA 24651
Phone (276) 988-2506

Interoperability endpoints

  • Direct secure messaging: proszem@ccf.org
  • Direct secure messaging: mbergen119126@direct.carilionclinic.org

Organizations & group practices 14

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.

View all 14

Hospital & facility affiliations 5

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1337558400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1673913600000",
    "number": "1407116718",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9500 EUCLID AVE",
            "city": "CLEVELAND",
            "state": "OH",
            "postal_code": "441950001",
            "telephone_number": "216-444-6640",
            "fax_number": "216-445-1492"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9500 EUCLID AVE",
            "city": "CLEVELAND",
            "state": "OH",
            "postal_code": "441951838",
            "telephone_number": "216-444-0617",
            "fax_number": "216-445-1492"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1906 Belleview Ave SE",
            "address_purpose": "LOCATION",
            "city": "Roanoke",
            "state": "VA",
            "postal_code": "240141838",
            "country_code": "US",
            "telephone_number": "540-981-7000",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "BERGEN",
        "first_name": "MICHAEL",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2012-05-21",
        "last_updated": "2023-01-17",
        "certification_date": "2023-01-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2085R0202X",
            "taxonomy_group": "",
            "desc": "Radiology, Diagnostic Radiology",
            "state": "VA",
            "license": "0101267361",
            "primary": false
        },
        {
            "code": "2085R0204X",
            "taxonomy_group": "",
            "desc": "Radiology, Vascular & Interventional Radiology",
            "state": "VA",
            "license": "0101267361",
            "primary": false
        },
        {
            "code": "208D00000X",
            "taxonomy_group": "",
            "desc": "General Practice",
            "state": "NY",
            "license": "2756654",
            "primary": false
        },
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": "NY",
            "license": null,
            "primary": false
        },
        {
            "code": "2085R0204X",
            "taxonomy_group": "",
            "desc": "Radiology, Vascular & Interventional Radiology",
            "state": "OH",
            "license": "35.146771",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "PROSZEM@ccf.org",
            "affiliation": "N",
            "endpointDescription": "business email",
            "address_1": "9500 Euclid Ave",
            "city": "Cleveland",
            "state": "OH",
            "country_code": "US",
            "postal_code": "441951838",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Cleveland, OH

Sources for this page

Verify at the official NPI Registry.