Individual provider Active NPI

Lara Von Berg, M.D., M.P.H.

  • Family Medicine Physician
  • Summit, NJ
National Provider Identifier
1558623330
Registry record updated Feb 22, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
25MA09617100 Issued in NJ
Practice address
11 Overlook Rd Ste 100
Summit, NJ 07901-3580
Phone
(908) 273-1493
NPI assigned
Jun 8, 2012
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 22, 2019

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 25MA09617100 NJ Primary

Addresses

Primary practice location

11 Overlook Rd Ste 100
Summit, NJ 07901-3580

Mailing address

PO Box 416457
Boston, MA 02241-6457
Phone (844) 362-1735

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NJ
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
I20150724010886 NJ Practitioner - Family Practice 5294048807 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Other, 2012
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Practice Associates Medical GroupGroup PAC ID 5890703177, 1,412 clinicians

Practice addresses (Care Compare)

100 Commerce PL
Clark, NJ 07066-1302
Phone (973) 829-4632

100 Madison Ave
Morristown, NJ 07960-6136
Phone (973) 971-5596

492 Main St
Chatham, NJ 07928-2142
Phone (973) 635-2432

Hospital & facility affiliations

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Practice Associates Medical Group Family Medicine CurrentSince Jul 15, 2015 Accepting new patients
New Jersey Family Medical Family Medicine Past Accepting new patients

Locations

492 Main St
Chatham, NJ 07928
Phone (973) 635-2432

100 Madison Ave
Morristown, NJ 07960
Phone (973) 538-5210

465 South St
Ste 103
Morristown, NJ 07960
Phone (973) 971-7130

11 Overlook Rd
Ste 100
Summit, NJ 07901
Phone (908) 273-1493

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 3

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": "1339113600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1550793600000",
    "number": "1558623330",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 416457",
            "city": "BOSTON",
            "state": "MA",
            "postal_code": "022416457",
            "telephone_number": "844-362-1735",
            "fax_number": "973-290-7495"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11 OVERLOOK RD STE 100",
            "city": "SUMMIT",
            "state": "NJ",
            "postal_code": "079013580",
            "telephone_number": "908-273-1493"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "VON BERG",
        "first_name": "LARA",
        "name_prefix": "Dr.",
        "credential": "M.D., M.P.H.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2012-06-08",
        "last_updated": "2019-02-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "NJ",
            "license": "25MA09617100",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Summit, NJ

Sources for this page

Verify at the official NPI Registry.