NPIMap

Individual provider Active NPI

Thomas Paul Bergman, P.A.

  • Physician Assistant
  • Maplewood, MN
National Provider Identifier
1558897173
Registry record updated Jun 16, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
12457 Issued in MN
Practice address
1575 Beam Ave
Maplewood, MN 55109-1126
Phone
(612) 863-6590
NPI assigned
May 2, 2017
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 16, 2020

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 12457 MN Primary

Addresses

Primary practice location

1575 Beam Ave
Maplewood, MN 55109-1126

Mailing address

6025 Lake Rd Ste 200
Woodbury, MN 55125-1710
Phone (651) 999-6800

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MN
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
I20170907000011 MN Practitioner - Physician Assistant 7113290511 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2017
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Minnesota Urology, PAGroup PAC ID 0840183984, 83 clinicians

Practice addresses (Care Compare)

1185 Town Centre Dr
Eagan, MN 55123-1189
Phone (651) 999-6800

500 Osborne Rd NE
Suite 120
Fridley, MN 55432-2767
Phone (651) 999-6800

6025 Lake Rd
Suite 200
Woodbury, MN 55125-1710
Phone (651) 999-6800

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
84.84 of 100Reported as group
Quality
64.59
Promoting interoperability
100
Improvement activities
40
Cost
84.88

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

State licenses

LicenseStateTypeSpecialty
12457MNMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Ecc Addiction & Toxicology Services LLC Past Accepting new patients

Interoperability endpoints

  • Direct secure messaging: thomas.bergman.1@20581.direct.athenahealth.com

Organizations & group practices 4

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.

Hospital & facility affiliations 22

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

View all 22

NPI Registry JSON

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

{
    "created_epoch": "1493683200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1592265600000",
    "number": "1558897173",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6025 LAKE RD STE 200",
            "city": "WOODBURY",
            "state": "MN",
            "postal_code": "551251710",
            "telephone_number": "651-999-6800",
            "fax_number": "651-999-6970"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1575 BEAM AVE",
            "city": "MAPLEWOOD",
            "state": "MN",
            "postal_code": "551091126",
            "telephone_number": "612-863-6590"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BERGMAN",
        "first_name": "THOMAS",
        "middle_name": "PAUL",
        "name_prefix": "Mr.",
        "credential": "P.A.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2017-05-02",
        "last_updated": "2020-06-16",
        "certification_date": "2020-06-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "MN",
            "license": "12457",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Maplewood, MN

Sources for this page

Verify at the official NPI Registry.