Nicole Elizabeth Berge, PA-C
Individual provider Active NPI Medical Physician Assistant · Shawnee Mission, KS
NPI 1457329575 · NPPES record last updated May 14, 2020
Key facts
- NPI
- 1457329575
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Medical Physician Assistant 363AM0700X
- License
- 15-01168 (KS)
- Practice address
- 7450 Kessler St Ste 203
Shawnee Mission, KS 66204-2519 - Phone
- (913) 676-7585
- Fax
- (913) 676-8189
- NPI assigned
- Mar 14, 2006
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 2
Hospital & facility affiliations 4
Medicare Care Compare profile
- Specialty
- Physician Assistant
- Education
- Other, 2000
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Telehealth
- Offers telehealth services
- Group practices
- Shawnee Mission Medical Center Inc
Practice addresses (Care Compare)
9301 W 74TH St
100 Ahmg Hematology Oncology at Shawnee
Merriam, KS 66204-2217
Phone (913) 632-9100
Hospital & facility affiliations
- Adventhealth Shawnee Mission
- Adventhealth South Overland Park, Inc
- Menorah Medical Center
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in KS
- 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 |
|---|---|---|---|---|
| I20080506000509 | KS | Practitioner - Physician Assistant | 7517046261 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Physician Assistant
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 085-001444 | IL | MD | Medical Physician Assistant |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Family Practice Associates CHTD | Past | Accepting new patients |
Interoperability endpoints
- nberge1207491@adventhealth.direct-ci.com
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Medical Physician Assistant | 363AM0700X | 085-001444 | IL | |
| Medical Physician Assistant | 363AM0700X | 15-01168 | KS | Yes |
Addresses
Primary practice location
7450 Kessler St Ste 203
Shawnee Mission, KS 66204-2519
Mailing address
16328 Nieman Rd
Overland Park, KS 66221-6421
Phone (630) 854-2931
Other names
- Nicole Elizabeth Gossen
Other providers in Shawnee Mission, KS
- Kyle Austin Bachamp
- Juanita Mayer Bartel
- Laine Marie Bassham
- Lisa Battani
- Taylor Daniels Bellinger
- Bethesda Lutheran Communities
- Bethesda Lutheran Communities
- Bethesda Lutheran Communities
- Michael J Bevers
- Shannon N. Blatny
All providers in Shawnee Mission, KS · Medical Physician Assistant in Kansas
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on May 14, 2020. 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).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.