NPIMap

Individual provider Active NPI

Sophea Bergen, PA-C

  • Physician Assistant
  • San Diego, CA
National Provider Identifier
1558300665
Registry record updated Nov 7, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
PA972 Issued in ID
Practice address
6719 Alvarado Rd Ste 308
San Diego, CA 92120-5268
Phone
(619) 265-7912
Fax
(619) 265-7922
NPI assigned
Jun 5, 2006
Last updated
Nov 7, 2019By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 7, 2019

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X PA972 ID Primary

Addresses

Primary practice location

6719 Alvarado Rd Ste 308
San Diego, CA 92120-5268

Mailing address

6719 Alvarado Rd Ste 308
San Diego, CA 92120-5268
Phone (619) 265-7912

Other practice location 1

700 W Ironwood Dr
Suite 350
Coeur D Alene, ID 83814-2656
Phone (208) 676-9913

Other names 1

  • Sophea Johansen Former name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20070313000339 CA Practitioner - Physician Assistant 0840393872 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2005
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
La Jolla Spine Institute Medical Group IncGroup PAC ID 6608802806, 8 clinicians

Practice addresses (Care Compare)

6719 Alvarado Rd
San Diego, CA 92120-5268
Phone (619) 265-7912

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled
HHS exclusion list flag
CMS’s directory marks this NPI as on an HHS exclusion list; no matching OIG record was found. The OIG exclusions file (LEIE) holds no record for this NPI, and the directory does not say which list the flag comes from. How exclusions are shown Confirm with the OIG exclusions search.
Credentials
Physician Assistant

State licenses

LicenseStateTypeSpecialty
PA972IDMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Scripps Health Current Accepting new patients
Kootenai Health, Inc. Past Accepting new patients
Kootenai Health, Inc. Physician Assistant Past Accepting new patients
Scripps Health Past Accepting new patients

Interoperability endpoints

  • Direct secure messaging: sbergen43489@scrippshlth.medalliesdirect.net
  • Direct secure messaging: sophea@lajollaspine.direct.cgm.us

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.

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": "1149465600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1573084800000",
    "number": "1558300665",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6719 ALVARADO RD STE 308",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921205268",
            "telephone_number": "619-265-7912",
            "fax_number": "619-265-7922"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6719 ALVARADO RD STE 308",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921205268",
            "telephone_number": "619-265-7912",
            "fax_number": "619-265-7922"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "700 W Ironwood Dr",
            "address_2": "Suite 350",
            "address_purpose": "LOCATION",
            "city": "Coeur D Alene",
            "state": "ID",
            "postal_code": "838142656",
            "country_code": "US",
            "telephone_number": "208-676-9913",
            "fax_number": "208-666-0885",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "BERGEN",
        "first_name": "SOPHEA",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-06-05",
        "last_updated": "2019-11-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "ID",
            "license": "PA972",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "SOPHEA",
            "last_name": "JOHANSEN",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in San Diego, CA

Sources for this page

Verify at the official NPI Registry.