Brent D Bergen, MD

Primary specialty

Pulmonary Disease PhysicianTaxonomy code 207RP1001X

License

2007001545 Issued in MO

Practice address

3800 S National Ave Ste 510
Springfield, MO 65807-5284

Phone

(417) 875-3160

NPI assigned

Aug 10, 2005

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 6

Medicare fee-for-service enrollment

Enrolled in MO

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

Specialty

Pulmonary Disease

Education

Other, 1990

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Select Specialty Hospital Springfield IncGroup PAC ID 9638250764, 7 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

All facility ownership & control disclosures 1

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

Owned or controlled facilities with NPI records 1

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

• Belleview Investment Group LLC

  • Skilled Nursing Facility
  • Belleview, MO
  • NPI 1114551694

  5% Or Greater Security Interest

  CMS ownership

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.

• Select Specialty Hospital Springfield Inc

  • Long Term Care Hospital
  • Springfield, MO
  • NPI 1821308180
  Medicare reassignment Care Compare group
• Ferrell Duncan Clinic, Inc

  • Multi-Specialty Clinic/Center
  • Springfield, MO
  • NPI 1326099383
  NPD (past)
• Ozarks Medical Center

  • General Acute Care Hospital
  • West Plains, MO
  • NPI 1831115641
  NPD (past)
• Pulmonary Associates of Owensboro PSC

  • Pulmonary Disease Physician
  • Owensboro, KY
  • NPI 1013919091
  NPD (past)

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

{
    "created_epoch": "1123632000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1545868800000",
    "number": "1629070693",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 9007",
            "city": "SPRINGFIELD",
            "state": "MO",
            "postal_code": "658089007",
            "telephone_number": "417-875-3462"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3800 S NATIONAL AVE STE 510",
            "city": "SPRINGFIELD",
            "state": "MO",
            "postal_code": "658075284",
            "telephone_number": "417-875-3160"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BERGEN",
        "first_name": "BRENT",
        "middle_name": "D",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-08-10",
        "last_updated": "2018-12-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207RP1001X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Pulmonary Disease",
            "state": "MO",
            "license": "2007001545",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "204593909",
            "state": "MO"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PASSPORT HEALTH",
            "identifier": "1069441",
            "state": "KY"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ANTHEM BCBS",
            "identifier": "000000048062",
            "state": "KY"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RR MEDICARE",
            "identifier": "290009315",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "200096100A",
            "state": "IN"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "64319783",
            "state": "KY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Carroll Gene Bentley, MD
• Megan Taylor Benton, PA
• Derek B Benz, PA-C
• Shelby Nicole Benz
• Haley Berg, RN
• Amanda Bergman, MSN, FNP
• Jonathan C Bergman, PHARM. D.
• Sarah R Bergquist, MACL, LPC
• Nina Elizabeth Bernard, MPT
• Jaime L Bernhardt, MSW, LMSW

• Pulmonary Disease Physician in Springfield, MO
• Providers in Springfield, MO by specialty
• Pulmonary Disease Physician in Missouri

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 27, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; facility enrollments, owners and changes of ownership; Provider of Services certification data; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.