Individual provider Active NPI

Gene Audley Bergmann, D.C.

  • Chiropractor
  • Glendora, CA
National Provider Identifier
1487713202
Registry record updated Jul 8, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
ChiropractorTaxonomy code 111N00000X
License
18329 Issued in CA
Practice address
109 N Vermont Ave
Glendora, CA 91741-3300
Phone
(626) 914-2359
Fax
(626) 852-1424
NPI assigned
Dec 7, 2006
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jul 8, 2007

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Chiropractor 111N00000X 18329 CA Primary

Addresses

Primary practice location

109 N Vermont Ave
Glendora, CA 91741-3300

Mailing address

109 N Vermont Ave
Glendora, CA 91741-3300
Phone (626) 914-2359

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20050209001094 CA Practitioner - Chiropractic 8325099062 Practice locations: Glendora, CA

Care Compare profile

Medicare Care Compare
Specialty
Chiropractic
Education
Los Angeles College of Chiropractic, 1986
Medicare assignment
Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

109 N Vermont Ave
Glendora, CA 91741-3300
Phone (626) 914-2359

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
18329CAMDCommunity Health Clinic/Center

NPI Registry JSON

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

{
    "created_epoch": "1165449600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1487713202",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "109 N VERMONT AVE",
            "city": "GLENDORA",
            "state": "CA",
            "postal_code": "917413300",
            "telephone_number": "626-914-2359",
            "fax_number": "626-852-1424"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "109 N VERMONT AVE",
            "city": "GLENDORA",
            "state": "CA",
            "postal_code": "917413300",
            "telephone_number": "626-914-2359",
            "fax_number": "626-852-1424"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BERGMANN",
        "first_name": "GENE",
        "middle_name": "AUDLEY",
        "name_prefix": "Dr.",
        "credential": "D.C.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-12-07",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "",
            "desc": "Chiropractor",
            "state": "CA",
            "license": "18329",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Glendora, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • 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.