Individual provider Active NPI

Daniel Bergh

  • Professional Counselor
  • Appleton, WI
National Provider Identifier
1487194452
Registry record updated Mar 17, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Professional CounselorTaxonomy code 101YP2500X
License
6755 Issued in WI
Practice address
320 S. Walnut St.
Appleton, WI 54911-5918
Phone
(920) 832-5270
NPI assigned
Feb 24, 2017
Last updated
Mar 17, 2020By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 17, 2020

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Mental Health Counselor 101YM0800X 3113226 WI
Mental Health Counselor 101YM0800X 3113-226 WI
Professional Counselor 101YP2500X 6755 WI Primary

Addresses

Primary practice location

320 S. Walnut St.
Appleton, WI 54911-5918

Mailing address

320 S. Walnut St.
Appleton, WI 54911-5918
Phone (920) 832-5270

Other identifiers 1

IdentifierTypeStateIssuer
100064881MedicaidWI

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WI
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

Enrollment IDStateProvider typePAC IDDetails
I20260112000658 WI Practitioner - Mental Health Counselor 0143724427 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Mental Health Counselor
Education
University of Wisconsin School of Medicine, 2016
Medicare assignment
May accept Medicare assignment

Practice addresses (Care Compare)

320 S Walnut St
Appleton, WI 54911-5918

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
3113-226WIMDMental Health Counselor
3113226WIMDMental Health Counselor
6755WIMDProfessional Counselor

Practice roles

OrganizationSpecialtyStatusNew patients
County of Outagamie CurrentSince Oct 31, 2025 Accepting new patients

Locations

320 S Walnut St
Appleton, WI 54911
Phone (920) 832-1624

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

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

{
    "created_epoch": "1487894400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1584403200000",
    "number": "1487194452",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "320 S. WALNUT ST.",
            "city": "APPLETON",
            "state": "WI",
            "postal_code": "549115918",
            "telephone_number": "920-832-5270"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "320 S. WALNUT ST.",
            "city": "APPLETON",
            "state": "WI",
            "postal_code": "549115918",
            "telephone_number": "920-832-5270"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BERGH",
        "first_name": "DANIEL",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2017-02-24",
        "last_updated": "2020-03-17",
        "certification_date": "2020-03-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "WI",
            "license": "3113226",
            "primary": false
        },
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "WI",
            "license": "3113-226",
            "primary": false
        },
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "WI",
            "license": "6755",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100064881",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Appleton, WI

Sources for this page

Verify at the official NPI Registry.