Nicole Marie Bergman, PA-C

Primary specialty

Medical Physician AssistantTaxonomy code 363AM0700X

License

50.003246 Issued in OH

Practice address

702 Commerce Dr
Suite 100
Perrysburg, OH 43551-5239

Phone

(419) 872-4673

Fax

(419) 873-8329

NPI assigned

Apr 5, 2011

Sex

Female

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 2

Medicare fee-for-service enrollment

Enrolled in OH

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Physician Assistant

Education

Other, 2010

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Hope Mitchell MD LLCGroup PAC ID 8123006483, 2 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

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.

• Hope Mitchell MD LLC

  • Dermatology Physician
  • Perrysburg, OH
  • NPI 1811178254
  Medicare reassignment Care Compare group

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

{
    "created_epoch": "1301961600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1478476800000",
    "number": "1639468184",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "815 COMMERCE DR",
            "address_2": "SUITE 100",
            "city": "PERRYSBURG",
            "state": "OH",
            "postal_code": "435515255",
            "telephone_number": "419-872-4673",
            "fax_number": "419-873-8329"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "702 COMMERCE DR",
            "address_2": "SUITE 100",
            "city": "PERRYSBURG",
            "state": "OH",
            "postal_code": "435515239",
            "telephone_number": "419-872-4673",
            "fax_number": "419-873-8329"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BERGMAN",
        "first_name": "NICOLE",
        "middle_name": "MARIE",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2011-04-05",
        "last_updated": "2016-11-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "OH",
            "license": "50.003246",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE GROUP",
            "identifier": "DD1846",
            "state": "OH"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE GROUP",
            "identifier": "9344881",
            "state": "OH"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Ta'Shayla Bell
• Paige Nadine Bellaire
• Belmont Nursing Center LLC
• Carly Benson
• Bentley Therapy Services, LLC
• Bonnie Berindean, PHARMD
• Deborah Ann Berlekamp, R.PH.
• Guillermo A Bernal, PH.D.
• Vicki Marie Bertka, M.D.
• Matthew Bethel

• Medical Physician Assistant in Perrysburg, OH
• Providers in Perrysburg, OH by specialty
• Medical Physician Assistant in Ohio

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 7, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; 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.