Individual provider Active NPI

James David Bergene, MD

  • Anesthesiology Physician
  • New Haven, CT
National Provider Identifier
1508285909
Registry record updated Dec 3, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Anesthesiology PhysicianTaxonomy code 207L00000X
License
79105 Issued in CT
Practice address
55 Lock St
New Haven, CT 06511-3603
Phone
(203) 688-8242
NPI assigned
Apr 14, 2014
Last updated
Dec 3, 2024By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 3, 2024

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

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
Anesthesiology Physician 207L00000X DR.0067337 CO
Anesthesiology Physician 207L00000X MD61311598 WA
Anesthesiology Physician 207L00000X 11718A WY
Anesthesiology Physician 207L00000X 79105 CT Primary

Addresses

Primary practice location

55 Lock St
New Haven, CT 06511-3603

Mailing address

PO Box 550
Torrington, WY 82240-0550
Phone (307) 630-1665

Other practice location 1

10350 E Dakota Ave
Denver, CO 80247-1314
Phone (303) 338-4545

Other practice location 2

489 State St
Bangor, ME 04401-6616
Phone (207) 973-7000

Other identifiers 1

IdentifierTypeStateIssuer
9000199882MedicaidCO

Electronic endpoints 1

TypeEndpointUseAffiliation
SOAP URL https://careepiceast.kp.org:14430/Interconnect-prodcom/wcf/epic.community.hie/xcpdrespondinggatewaysync.svc/ceq Health Information Exchange (HIE)

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WA, AK2 enrollments
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 2

Enrollment IDStateProvider typePAC IDDetails
I20230615000612 WA Practitioner - Anesthesiology 5294085106 Reassigns benefits to 2 organizations
I20260603004778 AK Practitioner - Anesthesiology 5294085106 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Anesthesiology
Education
Wake Forest University School of Medicine, 2014
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
HSS Anesthesia LLCGroup PAC ID 2567931389, 13 clinicians

Practice addresses (Care Compare)

2801 Debarr Rd
Anchorage, AK 99508-2932
Phone (907) 276-1131

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
85.73 of 100Reported as group
Quality
83.21
Improvement activities
40

Merit-based Incentive Payment System (MIPS)

Final score
73.51 of 100Reported as group
Quality
68.84
Improvement activities
40

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
79105CTMDAnesthesiology Physician
MD61311598WAMDAnesthesiology Physician
11718AWYMDAnesthesiology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Providence Health & Service- Washington Anesthesiology CurrentSince Feb 12, 2024 Accepting new patients
Columbia Anesthesia Group P S Anesthesiology CurrentSince Jun 1, 2023 Accepting new patients

Locations

101 W 8th Ave
Spokane, WA 99204
Phone (509) 474-3181

400 NE Mother Joseph Pl
Vancouver, WA 98664
Phone (360) 514-2000

Organizations & group practices 3

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.

Hospital & facility affiliations 1

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1397433600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1733184000000",
    "number": "1508285909",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 550",
            "city": "TORRINGTON",
            "state": "WY",
            "postal_code": "822400550",
            "telephone_number": "307-630-1665"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "55 LOCK ST",
            "city": "NEW HAVEN",
            "state": "CT",
            "postal_code": "065113603",
            "telephone_number": "203-688-8242"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "10350 E Dakota Ave",
            "address_purpose": "LOCATION",
            "city": "Denver",
            "state": "CO",
            "postal_code": "802471314",
            "country_code": "US",
            "telephone_number": "303-338-4545",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "489 State St",
            "address_purpose": "LOCATION",
            "city": "Bangor",
            "state": "ME",
            "postal_code": "044016616",
            "country_code": "US",
            "telephone_number": "207-973-7000",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "BERGENE",
        "first_name": "JAMES",
        "middle_name": "DAVID",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2014-04-14",
        "last_updated": "2024-12-03",
        "certification_date": "2024-12-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207L00000X",
            "taxonomy_group": "",
            "desc": "Anesthesiology",
            "state": "CO",
            "license": "DR.0067337",
            "primary": false
        },
        {
            "code": "207L00000X",
            "taxonomy_group": "",
            "desc": "Anesthesiology",
            "state": "WA",
            "license": "MD61311598",
            "primary": false
        },
        {
            "code": "207L00000X",
            "taxonomy_group": "",
            "desc": "Anesthesiology",
            "state": "WY",
            "license": "11718A",
            "primary": false
        },
        {
            "code": "207L00000X",
            "taxonomy_group": "",
            "desc": "Anesthesiology",
            "state": "CT",
            "license": "79105",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "9000199882",
            "state": "CO"
        }
    ],
    "endpoints": [
        {
            "endpointType": "SOAP",
            "endpointTypeDescription": "SOAP URL",
            "endpoint": "https://careepiceast.kp.org:14430/Interconnect-prodcom/wcf/epic.community.hie/xcpdrespondinggatewaysync.svc/ceq",
            "affiliation": "N",
            "endpointDescription": "Carequality",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "C-CDA",
            "address_1": "10350 E Dakota Ave",
            "city": "Denver",
            "state": "CO",
            "country_code": "US",
            "postal_code": "802471314",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in New Haven, CT

Sources for this page

Verify at the official NPI Registry.