Active NPI
Jennifer L Bergquist, M.D.
- Pediatrics Physician
- Chicago, IL
National Provider Identifier
1508973827
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pediatrics Physician
- License
- 036112898
- Practice address
- 1460 N Halsted St
Suite 402
Chicago, IL 60642 - Phone
- (312) 279-8900
- Fax
- (312) 981-6312
- NPI assigned
- Aug 23, 2006
- Last updated
- Sep 20, 2011
- Sex
- Female
- 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 |
|---|---|---|---|---|
| Pediatrics Physician | 208000000X | 036112898 | IL | Primary |
Addresses
Primary practice location
1460 N Halsted St
Suite 402
Chicago, IL 60642
Mailing address
1460 N Halsted St
Suite 402
Chicago, IL 60642
Phone (312) 279-8900
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in IL
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: Yes
Enrollment records 1
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 036112898 | IL | MD | Pediatrics Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Ann & Robert H. Lurie Children's Hospital of Chicago | Current | Accepting new patients | |
| Lurie Childrens Primary Care LLC | Pediatrics | Past | Accepting new patients |
| Town and Country Pediatrics | Pediatrics | Past | Accepting new patients |
| Lurie Children's Medical Group, LLC | Pediatrics | Past | Accepting new patients |
Locations
225 E Chicago Ave
Chicago, IL 60611
Phone (312) 227-6415
Interoperability endpoints
- jbergquist12874@direct.luriechildrens.org
Organizations & group practices 5
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.
-
- Children's Hospital
- Chicago, IL
- NPI 1235234535
-
- Pediatrics Physician
- Chicago, IL
- NPI 1134590995
-
- Pediatrics Physician
- Chicago, IL
- NPI 1740308196
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1156291200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1316476800000",
"number": "1508973827",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1460 N HALSTED ST",
"address_2": "SUITE 402",
"city": "CHICAGO",
"state": "IL",
"postal_code": "60642",
"telephone_number": "312-279-8900",
"fax_number": "312-981-6312"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1460 N HALSTED ST",
"address_2": "SUITE 402",
"city": "CHICAGO",
"state": "IL",
"postal_code": "60642",
"telephone_number": "312-279-8900",
"fax_number": "312-981-6312"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BERGQUIST",
"first_name": "JENNIFER",
"middle_name": "L",
"credential": "M.D.",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-08-23",
"last_updated": "2011-09-20",
"status": "A"
},
"taxonomies": [
{
"code": "208000000X",
"taxonomy_group": "",
"desc": "Pediatrics",
"state": "IL",
"license": "036112898",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Chicago, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 20, 2011; 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.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.