Victoria A Bergeson, APRN
Individual provider Active NPI Family Nurse Practitioner · Mystic, CT
NPI 1447730916 · NPPES record last updated May 9, 2023
Key facts
- NPI
- 1447730916
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Family Nurse Practitioner 363LF0000X
- License
- 7765 (CT)
- Practice address
- 11 Main St Ste 202
Mystic, CT 06355-3654 - Phone
- (860) 912-8444
- NPI assigned
- Aug 15, 2018
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 2
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in CT
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: No
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20181005000126 | CT | Practitioner - Nurse Practitioner | 6800148693 | Reassigns benefits to 2 organizations |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Nurse Practitioner
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 7765 | CT | MD | Family Nurse Practitioner |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Matrix Medical Plus | Current |
Accepting new patients | |
| Hartford Healthcare Urgent Care Centers, LLC | Current |
Accepting new patients |
Locations
9201 E Mountain View Rd
Ste 220
Scottsdale, AZ 85258
Phone (480) 862-1883
385 W Main St
Avon, CT 06001
Phone (860) 777-1280
1224 Mill St
Bldg B
East Berlin, CT 06023
Phone (860) 406-4894
624 W Main St
Norwich, CT 06360
Phone (860) 200-8098
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Student in an Organized Health Care Education/Training Program | 390200000X | |||
| Family Nurse Practitioner | 363LF0000X | 7765 | CT | Yes |
Addresses
Primary practice location
11 Main St Ste 202
Mystic, CT 06355-3654
Mailing address
11 Main St Ste 202
Mystic, CT 06355-3654
Phone (860) 912-8444
Other providers in Mystic, CT
- Beth B Avery
- Melissa Elizabeth Avery
- Chelsea Andrea Barabtarlo
- Christine M Bauch
- Benchmark Assisted Living LLC
- Bruce A. Berlow
- Emily Beyene
- Big Y Foods, Inc
- Valerie Bilheimer
- Natalie B. Billing
All providers in Mystic, CT · Family Nurse Practitioner in Connecticut
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on May 9, 2023. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.