Active NPI
Evan Berg
- Clinical Social Worker
- Portsmouth, NH
National Provider Identifier
1497297873
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Social Worker
- License
- 2256
- Practice address
- 1145 Sagamore Ave
Portsmouth, NH 03801-5503 - Phone
- (603) 431-6703
- Fax
- (603) 430-3753
- NPI assigned
- Nov 16, 2016
- Last updated
- Jan 8, 2020
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Social Worker | 1041C0700X | 2256 | NH | Primary |
Addresses
Primary practice location
1145 Sagamore Ave
Portsmouth, NH 03801-5503
Mailing address
1145 Sagamore Ave
Portsmouth, NH 03801-5503
Phone (603) 431-6703
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 3078870 | Medicaid | NH |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Opted out of Medicare
- Yes, effective Feb 10, 2025 through Feb 10, 2027
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 2256 | NH | MD | Clinical Social Worker |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1479254400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1578441600000",
"number": "1497297873",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1145 SAGAMORE AVE",
"city": "PORTSMOUTH",
"state": "NH",
"postal_code": "038015503",
"telephone_number": "603-431-6703",
"fax_number": "603-430-3753"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1145 SAGAMORE AVE",
"city": "PORTSMOUTH",
"state": "NH",
"postal_code": "038015503",
"telephone_number": "603-431-6703",
"fax_number": "603-430-3753"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BERG",
"first_name": "EVAN",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2016-11-16",
"last_updated": "2020-01-08",
"certification_date": "2020-01-08",
"status": "A"
},
"taxonomies": [
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "NH",
"license": "2256",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "3078870",
"state": "NH"
}
],
"endpoints": [],
"other_names": []
}Other providers in Portsmouth, NH
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 8, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Opt Out Affidavits.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.