Jacob Berger, M.D.

Primary specialty

Neurology PhysicianTaxonomy code 2084N0400X

License

MD12584 Issued in RI

Practice address

830 Chalkstone Ave
Providence VA Medical Center, Dept of Neurology
Providence, RI 02908-4734

Phone

(401) 273-7100

NPI assigned

Dec 15, 2006

Last updated

Mar 7, 2023By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 5

Medicare fee-for-service enrollment

Enrolled in RI

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 1

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

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

{
    "created_epoch": "1166140800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1678147200000",
    "number": "1457413379",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "830 CHALKSTONE AVE",
            "address_2": "PROVIDENCE VA MEDICAL CENTER, DEPT OF NEUROLOGY",
            "city": "PROVIDENCE",
            "state": "RI",
            "postal_code": "029084734",
            "telephone_number": "401-273-7100"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "830 CHALKSTONE AVE",
            "address_2": "PROVIDENCE VA MEDICAL CENTER, DEPT OF NEUROLOGY",
            "city": "PROVIDENCE",
            "state": "RI",
            "postal_code": "029084734",
            "telephone_number": "401-273-7100"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BERGER",
        "first_name": "JACOB",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-12-15",
        "last_updated": "2023-03-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2084N0400X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Neurology",
            "state": "RI",
            "license": "MD12584",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RI LICENSE",
            "identifier": "12584",
            "state": "RI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "UHC",
            "identifier": "2575620",
            "state": "NY"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "02682699",
            "state": "NY"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MVP",
            "identifier": "790791",
            "state": "NY"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "OXFORD",
            "identifier": "P3628039",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Geoffrey Herbst Berg, MD
• Hallie Bergen, PHARMD, RPH
• Mary Clare Bergen, NP
• Brian Berger, LICSW
• Eric E. Berger, MD
• Judith Michelle Berger, LICSW
• Karlo Berger, LCMT
• Meredith Bergeron Piti, LMHC
• Jodi Bergeron
• Megan Bergeron

• Neurology Physician in Providence, RI
• Providers in Providence, RI by specialty
• Neurology Physician in Rhode Island

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 7, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.