NPIMap

Organization Active NPI

Colorado Springs Radiologists PC

  • Diagnostic Radiology Physician
  • Colorado Springs, CO
National Provider Identifier
1629168406
Registry record updated Nov 3, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Diagnostic Radiology PhysicianTaxonomy code 2085R0202X
Legal business name
COLORADO SPRINGS RADIOLOGISTS PC
Practice address
2222 N Nevada Ave
Colorado Springs, CO 80907-6819
Phone
(719) 593-1799
Fax
(719) 265-3794
NPI assigned
Oct 13, 2006
Last updated
Nov 3, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 3, 2020

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

Authorized official

Name
Derek Scott Bergeson, MD
Title
Radiologist
Phone
(719) 593-1799

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Diagnostic Radiology Physician 2085R0202X NU Primary

Addresses

Primary practice location

2222 N Nevada Ave
Colorado Springs, CO 80907-6819

Mailing address

PO Box 2989
Colorado Springs, CO 80901-2989
Phone (719) 593-1799

Other identifiers 1

IdentifierTypeStateIssuer
04051082MedicaidCO

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CO, AZ, OR, VA, WA5 enrollments

Enrollment records 5

Enrollment IDStateProvider typePAC IDDetails
O20040412001373 CO Part B Supplier - Clinic/Group Practice 6901890094 Receives reassigned benefits from 23 practitioners
Practice locations: Colorado Springs, CO
O20221020000697 AZ Part B Supplier - Clinic/Group Practice 6901890094 Receives reassigned benefits from 2 practitioners
Practice locations: Phoenix, AZ; Cave Creek, AZ
O20230105000433 OR Part B Supplier - Clinic/Group Practice 6901890094 Receives reassigned benefits from 2 practitioners
Practice locations: Portland, OR; Lake Oswego, OR
O20230224001134 VA Part B Supplier - Clinic/Group Practice 6901890094 Receives reassigned benefits from 1 practitioner
Practice locations: Chesapeake, VA
O20241001003060 WA Part B Supplier - Clinic/Group Practice 6901890094 Receives reassigned benefits from 1 practitioner
Practice locations: Camas, WA

Other NPIs with the same Medicare PAC ID 2

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

National Provider Directory

National Provider Directory

Locations

1390 Kelly Johnson Blvd
Colorado Springs, CO 80920
Phone (714) 400-6934

3205 N Academy Blvd
Colorado Springs, CO 80917
Phone (719) 776-3000

Practitioners & affiliated clinicians

Practitioners 33

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 33

NPI Registry JSON

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

{
    "created_epoch": "1160697600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1604361600000",
    "number": "1629168406",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 2989",
            "city": "COLORADO SPRINGS",
            "state": "CO",
            "postal_code": "809012989",
            "telephone_number": "719-593-1799",
            "fax_number": "719-265-3794"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2222 N NEVADA AVE",
            "city": "COLORADO SPRINGS",
            "state": "CO",
            "postal_code": "809076819",
            "telephone_number": "719-593-1799",
            "fax_number": "719-265-3794"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COLORADO SPRINGS RADIOLOGISTS PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-10-13",
        "last_updated": "2020-11-03",
        "certification_date": "2020-11-03",
        "status": "A",
        "authorized_official_last_name": "BERGESON",
        "authorized_official_first_name": "DEREK",
        "authorized_official_middle_name": "SCOTT",
        "authorized_official_title_or_position": "RADIOLOGIST",
        "authorized_official_telephone_number": "719-593-1799",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "2085R0202X",
            "taxonomy_group": "",
            "desc": "Radiology, Diagnostic Radiology",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "04051082",
            "state": "CO"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Colorado Springs, CO

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 3, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.