NPIMap

Individual provider Active NPI

Audrey Bergeson, M.D.

  • Emergency Medicine Physician
  • Provo, UT
National Provider Identifier
1427478577
Registry record updated Dec 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Emergency Medicine PhysicianTaxonomy code 207P00000X
License
11439161-1205 Issued in UT
Practice address
1034 N 500 W
Provo, UT 84604-3380
Phone
(801) 357-7850
NPI assigned
Apr 16, 2014
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 22, 2020

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Emergency Medicine Physician 207P00000X Q9957 TX
Emergency Medicine Physician 207P00000X BP10049734 TX
Emergency Medicine Physician 207P00000X 11439161-1205 UT Primary

Addresses

Primary practice location

1034 N 500 W
Provo, UT 84604-3380

Mailing address

PO Box 10
Spanish Fork, UT 84660-0019
Phone (330) 903-3294

Other practice location 1

1504 Taub Loop
Ben Taub General Hospital, Emergency Center
Houston, TX 77030-1608
Phone (713) 873-7045

Other names 1

  • Audrey Bergeson Former name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TX, UT2 enrollments
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20170620001379 TX Practitioner - Emergency Medicine 0941578710 Reassigns benefits to 1 organization
I20191219000644 UT Practitioner - Emergency Medicine 0941578710 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Emergency Medicine
Education
Other, 2014
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Utah Valley Emergency Physicians IncGroup PAC ID 2860390879, 34 clinicians

Practice addresses (Care Compare)

331 N 400
Orem, UT 84057-1913
Phone (801) 224-4080

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
BP10049734TXMDEmergency Medicine Physician
Q9957TXMDEmergency Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Castleview Physician Practices LLC CurrentSince Nov 15, 2021 Accepting new patients
Baylor College of Medicine CurrentSince Jul 1, 2017 Accepting new patients
West Emergency Services, LLC Emergency Medicine CurrentSince Feb 1, 2022 Accepting new patients
Utah Valley Emergency Physicians Inc Emergency Medicine CurrentSince Feb 1, 2021 Accepting new patients
Baylor College of Medicine CurrentSince Jul 1, 2017 Accepting new patients
Castleview Physician Practice LLC Current Accepting new patients
Castleview Physician Practice, LLC CurrentSince Nov 15, 2021 Accepting new patients

Locations

2 Greenway Plz
Ste 900
Houston, TX 77046
Phone (713) 798-1835

1504 Taub Loop
Houston, TX 77030
Phone (713) 873-2860

331 N 400 W
Orem, UT 84057
Phone (801) 224-4080

945 W Hospital Dr
Ste 1
Price, UT 84501
Phone (435) 637-4327

300 N Hospital Dr
Price, UT 84501
Phone (435) 636-4836

1034 N 500 W
Provo, UT 84604
Phone (801) 362-4119

Organizations & group practices 7

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.

Hospital & facility affiliations 4

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": "1397606400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1608595200000",
    "number": "1427478577",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 10",
            "city": "SPANISH FORK",
            "state": "UT",
            "postal_code": "846600019",
            "telephone_number": "330-903-3294"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1034 N 500 W",
            "city": "PROVO",
            "state": "UT",
            "postal_code": "846043380",
            "telephone_number": "801-357-7850"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1504 Taub Loop",
            "address_2": "Ben Taub General Hospital, Emergency Center",
            "address_purpose": "LOCATION",
            "city": "Houston",
            "state": "TX",
            "postal_code": "770301608",
            "country_code": "US",
            "telephone_number": "713-873-7045",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "BERGESON",
        "first_name": "AUDREY",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2014-04-16",
        "last_updated": "2020-12-22",
        "certification_date": "2020-12-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "TX",
            "license": "Q9957",
            "primary": false
        },
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "TX",
            "license": "BP10049734",
            "primary": false
        },
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "UT",
            "license": "11439161-1205",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "AUDREY",
            "last_name": "BERGESON",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Provo, UT

Sources for this page

Verify at the official NPI Registry.