Active NPI
Richard Dennis Bertken, MD
- Rheumatology Physician
- Fresno, CA
National Provider Identifier
1609895150
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Rheumatology Physician
- License
- G30979
- Practice address
- 290 N Wayte LN Ste 2300
Fresno, CA 93701-2124 - Phone
- (866) 342-6012
- NPI assigned
- Jul 18, 2006
- Last updated
- Jan 27, 2021
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Internal Medicine Physician | 207R00000X | G30979 | CA | |
| Rheumatology Physician | 207RR0500X | G30979 | CA | Primary |
Addresses
Primary practice location
290 N Wayte LN Ste 2300
Fresno, CA 93701-2124
Mailing address
2625 E Divisadero St
Fresno, CA 93721-1431
Phone (559) 443-2682
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| BA311Z | Other | CA | PTAN |
| 00G309790 | Medicaid | CA |
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 |
|---|---|---|---|
| 30979 | CA | MD | Orthodontics and Dentofacial Orthopedic Dentist |
| G30979 | CA | MD | Rheumatology Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Nia Healthcare Services, Inc. | Past | Accepting new patients | |
| University Faculty Associates, Inc. | Past | Accepting new patients |
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.
-
dba Selma Convalescent Hospital
- Skilled Nursing Facility
- Selma, CA
- NPI 1134269533
-
- Emergency Medicine Physician
- Fresno, CA
- NPI 1235537283
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1153180800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1611705600000",
"number": "1609895150",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2625 E DIVISADERO ST",
"city": "FRESNO",
"state": "CA",
"postal_code": "937211431",
"telephone_number": "559-443-2682",
"fax_number": "559-443-2681"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "290 N WAYTE LN STE 2300",
"city": "FRESNO",
"state": "CA",
"postal_code": "937012124",
"telephone_number": "866-342-6012"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BERTKEN",
"first_name": "RICHARD",
"middle_name": "DENNIS",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-07-18",
"last_updated": "2021-01-27",
"certification_date": "2021-01-27",
"status": "A"
},
"taxonomies": [
{
"code": "207R00000X",
"taxonomy_group": "",
"desc": "Internal Medicine",
"state": "CA",
"license": "G30979",
"primary": false
},
{
"code": "207RR0500X",
"taxonomy_group": "",
"desc": "Internal Medicine, Rheumatology",
"state": "CA",
"license": "G30979",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "PTAN",
"identifier": "BA311Z",
"state": "CA"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "00G309790",
"state": "CA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Fresno, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 27, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.