Patricia S. Bergstrom, LCSW

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

LC5701 Issued in ME

Practice address

57 Water Street
Blue Hill, ME 04614

Phone

(207) 374-2311

Fax

(207) 374-3991

NPI assigned

Mar 25, 2009

Last updated

Jan 20, 2021By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Other identifiers 1

Other names 1

• Patricia S. Herklotz Former name

Electronic endpoints 2

Medicare fee-for-service enrollment

Enrolled in ME

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Merit-based Incentive Payment System (MIPS)

Final score

93.25 of 100Reported as group

Quality

86.48

Promoting interoperability

100

Improvement activities

40

Medicare enrollment (NPD)

Enrolled

State licenses

Interoperability endpoints

• Direct secure messaging: pbergstrom@direct.emhs.org

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

{
    "created_epoch": "1237939200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1611100800000",
    "number": "1477795292",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "57 WATER STREET",
            "city": "BLUE HILL",
            "state": "ME",
            "postal_code": "04614",
            "telephone_number": "207-374-2311",
            "fax_number": "207-374-3991"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "57 WATER STREET",
            "city": "BLUE HILL",
            "state": "ME",
            "postal_code": "04614",
            "telephone_number": "207-374-2311",
            "fax_number": "207-374-3991"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BERGSTROM",
        "first_name": "PATRICIA",
        "middle_name": "S.",
        "credential": "LCSW",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2009-03-25",
        "last_updated": "2021-01-20",
        "certification_date": "2021-01-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": "ME",
            "license": "LC1463",
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "ME",
            "license": "LC5701",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1477795292",
            "state": "ME"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "pbergstrom@direct.emhs.org",
            "affiliation": "N",
            "address_1": "57 Water Street",
            "city": "Blue Hill",
            "state": "ME",
            "country_code": "US",
            "postal_code": "04614",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "pbergstrom@direct.emhs.org",
            "affiliation": "N",
            "address_1": "57 Water Street",
            "city": "Blue Hill",
            "state": "ME",
            "country_code": "US",
            "postal_code": "04614",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "first_name": "PATRICIA",
            "last_name": "HERKLOTZ",
            "middle_name": "S.",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

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• Clinical Social Worker in Blue Hill, ME
• Providers in Blue Hill, ME by specialty
• Clinical Social Worker in Maine

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 20, 2021; 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.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.