Individual provider Active NPI

Patrick John Berger, D.O.

  • Geriatric Medicine (Internal Medicine) Physician
  • Jacksonville, FL
National Provider Identifier
1629173273
Registry record updated Dec 21, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Geriatric Medicine (Internal Medicine) PhysicianTaxonomy code 207RG0300X
License
OS9169 Issued in FL
Practice address
3059 Edgewood Ave W
Jacksonville, FL 32209-2207
Phone
(904) 647-3180
Fax
(904) 425-9030
NPI assigned
Sep 14, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 21, 2022

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Geriatric Medicine (Internal Medicine) Physician 207RG0300X OS9169 FL Primary

Addresses

Primary practice location

3059 Edgewood Ave W
Jacksonville, FL 32209-2207

Mailing address

3059 Edgewood Ave W
Jacksonville, FL 32209-2207
Phone (904) 647-3180

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in FL
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

Enrollment IDStateProvider typePAC IDDetails
I20040617001408 FL Practitioner - Internal MedicinePractitioner - Geriatric Medicine 9436133147 Reassigns benefits to 2 organizations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Osteopathy

State licenses

LicenseStateTypeSpecialty
OS9161FLMDFamily Medicine Physician
000508CTMDPhysical Therapy Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Dedicated Senior Medical Center of Florida, LLC CurrentSince Jan 1, 2023 Accepting new patients
Dedicated Senior Medical Center of Florida, LLC CurrentSince Jan 1, 2023 Accepting new patients
Central Florida Inpatient Medicine LLC CurrentSince Jul 13, 2019 Accepting new patients
Masonicare Behavioral Health, LLC PastSince Dec 17, 2007 Accepting new patients
Halifax Healthcare Systems Inc Past Accepting new patients
Masonicare Primary Care Physicians Geriatric Medicine PastSince Oct 1, 2001 Accepting new patients

Locations

3059 Edgewood Ave W
Jacksonville, FL 32209
Phone (904) 647-3180

8000 Lem Turner Rd
#2
Jacksonville, FL 32208
Phone (904) 539-8200

525 Technology Park
Ste 109
Lake Mary, FL 32746
Phone 4076472346 ext. 111

4715 S Florida Ave
Lakeland, FL 33813
Phone (863) 209-7003

1395 NW 167th St
Miami Gardens, FL 33169
Phone (305) 831-4760

Networks

  • Optimum HealthCare HMO Network
  • Freedom Health HMO Network

Organizations & group practices 6

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.

NPI Registry JSON

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

{
    "created_epoch": "1158192000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1671580800000",
    "number": "1629173273",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3059 EDGEWOOD AVE W",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322092207",
            "telephone_number": "904-647-3180",
            "fax_number": "904-425-9030"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3059 EDGEWOOD AVE W",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322092207",
            "telephone_number": "904-647-3180",
            "fax_number": "904-425-9030"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BERGER",
        "first_name": "PATRICK",
        "middle_name": "JOHN",
        "name_prefix": "Dr.",
        "credential": "D.O.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-09-14",
        "last_updated": "2022-12-21",
        "certification_date": "2022-12-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207RG0300X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Geriatric Medicine",
            "state": "FL",
            "license": "OS9169",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Jacksonville, FL

Sources for this page

Verify at the official NPI Registry.