Brock Daryl Bernsten, MD
Individual provider Active NPI Pediatrics Physician · Springfield, OR
NPI 1528070752 · NPPES record last updated Jul 15, 2021
Key facts
- NPI
- 1528070752
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Pediatrics Physician 208000000X
- License
- MD190026 (OR)
- Practice address
- 3377 Riverbend Dr
Springfield, OR 97477-8803 - Phone
- (541) 222-8500
- Fax
- (541) 222-6435
- NPI assigned
- Aug 13, 2006
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 3
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in OR
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20190412001784 | OR | Practitioner - Pediatric Medicine | 5890036115 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| MD190026 | OR | MD | Pediatrics Physician |
| C37164 | CA | MD | Pediatric Adolescent Medicine Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Peacehealth Medical Group | Pediatrics | Current |
Accepting new patients |
| Peacehealth | Past | Accepting new patients | |
| California Pacific Medical Group, Inc. | Past | Accepting new patients |
Locations
1200 Hilyard St
Ste 440
Eugene, OR 97401
Phone (458) 205-6061
4010 Aerial Way
Eugene, OR 97402
Phone (541) 242-8300
1115 SE 164th Ave
Dept 358
Vancouver, WA 98683
Phone (360) 729-1253
Interoperability endpoints
- bbernsten395939@direct.peacehealth.org
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pediatric Adolescent Medicine Physician | 2080A0000X | C37164 | CA | |
| Pediatrics Physician | 208000000X | MD190026 | OR | Yes |
Addresses
Primary practice location
3377 Riverbend Dr
Springfield, OR 97477-8803
Mailing address
PO Box 748636
Los Angeles, CA 90074-1522
Phone (877) 202-3597
Other practice location 1
1200 Hilyard St Ste 440
Eugene, OR 97401-8122
Phone (458) 205-6061
Other practice location 2
3838 California St
ste. 111
San Francisco, CA 94118-1522
Phone (415) 666-1860
Other providers in Springfield, OR
- Rebecca Clare Bent
- Aaron Berger
- Alicia Berger
- Bo Eric Bergeson
- Walter D Bernard
- Ruthie Faye Berrell
- Better Horizons in-Home Care, Inc
- Jamie Beverly
- Mike Beverly
- Ann Joleen Bezuk
All providers in Springfield, OR · Pediatrics Physician in Oregon
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 15, 2021. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.