Active NPI
Diane K Bergau, M.D.
- Diagnostic Radiology Physician
- Cocoa Beach, FL
National Provider Identifier
1609884527
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Diagnostic Radiology Physician
- License
- ME747701
- Practice address
- 701 W Cocoa Beach Cswy
Cocoa Beach, FL 32931-3585 - Phone
- (321) 799-7111
- Fax
- (770) 237-4866
- NPI assigned
- Aug 4, 2006
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 6
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Body Imaging Physician | 2085B0100X | ME747701 | FL | |
| Nuclear Radiology Physician | 2085N0904X | ME747701 | FL | |
| Pediatric Radiology Physician | 2085P0229X | ME747701 | FL | |
| Diagnostic Radiology Physician | 2085R0202X | ME747701 | FL | Primary |
| Vascular & Interventional Radiology Physician | 2085R0204X | ME747701 | FL | |
| Diagnostic Ultrasound Physician | 2085U0001X | ME747701 | FL |
Addresses
Primary practice location
701 W Cocoa Beach Cswy
Cocoa Beach, FL 32931-3585
Mailing address
PO Box 2400
Melbourne, FL 32902-2400
Phone (866) 744-1461
Other identifiers 4
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 062324500 | Medicaid | FL | |
| 10851U | Other | FL | MEDICARE PTAN |
| 10851 | Other | FL | BCBS |
| 30048846 | Other | MEDICARE RR |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| ME747701 | FL | MD | Pediatric Radiology Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1154649600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1375660800000",
"number": "1609884527",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 2400",
"city": "MELBOURNE",
"state": "FL",
"postal_code": "329022400",
"telephone_number": "866-744-1461",
"fax_number": "770-621-3181"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "701 W COCOA BEACH CSWY",
"city": "COCOA BEACH",
"state": "FL",
"postal_code": "329313585",
"telephone_number": "321-799-7111",
"fax_number": "770-237-4866"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BERGAU",
"first_name": "DIANE",
"middle_name": "K",
"credential": "M.D.",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-08-04",
"last_updated": "2013-08-05",
"status": "A"
},
"taxonomies": [
{
"code": "2085B0100X",
"taxonomy_group": "",
"desc": "Radiology, Body Imaging",
"state": "FL",
"license": "ME747701",
"primary": false
},
{
"code": "2085N0904X",
"taxonomy_group": "",
"desc": "Radiology, Nuclear Radiology",
"state": "FL",
"license": "ME747701",
"primary": false
},
{
"code": "2085P0229X",
"taxonomy_group": "",
"desc": "Radiology, Pediatric Radiology",
"state": "FL",
"license": "ME747701",
"primary": false
},
{
"code": "2085R0202X",
"taxonomy_group": "",
"desc": "Radiology, Diagnostic Radiology",
"state": "FL",
"license": "ME747701",
"primary": true
},
{
"code": "2085R0204X",
"taxonomy_group": "",
"desc": "Radiology, Vascular & Interventional Radiology",
"state": "FL",
"license": "ME747701",
"primary": false
},
{
"code": "2085U0001X",
"taxonomy_group": "",
"desc": "Radiology, Diagnostic Ultrasound",
"state": "FL",
"license": "ME747701",
"primary": false
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "062324500",
"state": "FL"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MEDICARE PTAN",
"identifier": "10851U",
"state": "FL"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BCBS",
"identifier": "10851",
"state": "FL"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MEDICARE RR",
"identifier": "30048846",
"state": null
}
],
"endpoints": [],
"other_names": []
}Other providers in Cocoa Beach, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 5, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.