Individual provider Active NPI

Roger L Berkow, MD

  • Pediatric Hematology & Oncology Physician
  • Atlanta, GA
National Provider Identifier
1528055753
Registry record updated Jan 12, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatric Hematology & Oncology PhysicianTaxonomy code 2080P0207X
License
86596 Issued in GA
Practice address
35 Jesse Hill Jr Dr SE
Atlanta, GA 30303-3032
Phone
(404) 785-9850
NPI assigned
Oct 3, 2005
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 12, 2021

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

Specialties & licenses 6

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatrics Physician 208000000X ME117016 FL
Pediatric Hematology & Oncology Physician 2080P0207X MD.11429 AL
Pediatric Hematology & Oncology Physician 2080P0207X ME117016 FL
Pediatric Hematology & Oncology Physician 2080P0207X 86596 GA Primary
Pediatrics Physician 208000000X MD.11429 AL
Emergency Medicine Physician 207P00000X MD.11429 AL

Addresses

Primary practice location

35 Jesse Hill Jr Dr SE
Atlanta, GA 30303-3032

Mailing address

720 Westview Drive SW
Harris BLDG., 100-a
Atlanta, GA 30310
Phone (404) 756-1400

Other identifiers 4

IdentifierTypeStateIssuer
009928300MedicaidAL
1528055753OtherALTRICARE SOUTH
510-95530OtherALBCBS
5656157OtherALAETNA

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in GA
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 1

Enrollment IDStateProvider typePAC IDDetails
I20201130002955 GA Practitioner - Pediatric Medicine 0840427597 Reassigns benefits to 1 organization

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
MD.11429ALMDPediatric Hematology & Oncology Physician
86596GAMDPediatric Hematology & Oncology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Morehouse Healthcare, Inc. Pediatrics CurrentSince Dec 1, 2020 Accepting new patients
The Children's Hospital of Alabama Pediatrics Past Accepting new patients

Locations

1800 Howell Mill Rd NW
Ste 550
Atlanta, GA 30318
Phone (404) 756-1290

720 Westview Dr SW
Bldg 100A
Atlanta, GA 30310

35 Jesse Hill Jr Dr SE
Atlanta, GA 30303
Phone (404) 785-9500

1595 Cleveland Ave
East Point, GA 30344
Phone (404) 305-8086

Organizations & group practices 2

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

NPI Registry JSON

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

{
    "created_epoch": "1128297600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1610409600000",
    "number": "1528055753",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "720 WESTVIEW DRIVE SW",
            "address_2": "HARRIS BLDG., 100-A",
            "city": "ATLANTA",
            "state": "GA",
            "postal_code": "30310",
            "telephone_number": "404-756-1400"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "35 JESSE HILL JR DR SE",
            "city": "ATLANTA",
            "state": "GA",
            "postal_code": "303033032",
            "telephone_number": "404-785-9850"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BERKOW",
        "first_name": "ROGER",
        "middle_name": "L",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-10-03",
        "last_updated": "2021-01-12",
        "certification_date": "2021-01-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "FL",
            "license": "ME117016",
            "primary": false
        },
        {
            "code": "2080P0207X",
            "taxonomy_group": "",
            "desc": "Pediatrics, Pediatric Hematology-Oncology",
            "state": "AL",
            "license": "MD.11429",
            "primary": false
        },
        {
            "code": "2080P0207X",
            "taxonomy_group": "",
            "desc": "Pediatrics, Pediatric Hematology-Oncology",
            "state": "FL",
            "license": "ME117016",
            "primary": false
        },
        {
            "code": "2080P0207X",
            "taxonomy_group": "",
            "desc": "Pediatrics, Pediatric Hematology-Oncology",
            "state": "GA",
            "license": "86596",
            "primary": true
        },
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "AL",
            "license": "MD.11429",
            "primary": false
        },
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "AL",
            "license": "MD.11429",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "009928300",
            "state": "AL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "TRICARE SOUTH",
            "identifier": "1528055753",
            "state": "AL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "510-95530",
            "state": "AL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AETNA",
            "identifier": "5656157",
            "state": "AL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Atlanta, GA

Sources for this page

Verify at the official NPI Registry.