Kenneth R Bergman Jr., MD

Primary specialty

Sleep Medicine (Otolaryngology) PhysicianTaxonomy code 207YS0012X

License

0101102580 Issued in VA

Practice address

4116 Brown Mountain LN
Elkton, VA 22827-3409

Phone

(571) 246-7223

NPI assigned

Mar 9, 2006

Last updated

Jan 2, 2025By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in VA

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

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: kenneth.bergman@lmg1.eclinicaldirectplus.com

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.

• Loudoun Medical Group, PC

  • Internal Medicine Physician
  • Leesburg, VA
  • NPI 1679591440

  Otolaryngology

  Medicare reassignment NPD

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

{
    "created_epoch": "1141862400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1735776000000",
    "number": "1659349447",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4116 BROWN MOUNTAIN LN",
            "city": "ELKTON",
            "state": "VA",
            "postal_code": "228273409",
            "telephone_number": "571-246-7223"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4116 BROWN MOUNTAIN LN",
            "city": "ELKTON",
            "state": "VA",
            "postal_code": "228273409",
            "telephone_number": "571-246-7223"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BERGMAN",
        "first_name": "KENNETH",
        "middle_name": "R",
        "name_prefix": "Dr.",
        "name_suffix": "Jr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-03-09",
        "last_updated": "2025-01-02",
        "certification_date": "2025-01-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207YS0012X",
            "taxonomy_group": "",
            "desc": "Otolaryngology, Sleep Medicine",
            "state": "VA",
            "license": "0101102580",
            "primary": true
        },
        {
            "code": "207Y00000X",
            "taxonomy_group": "",
            "desc": "Otolaryngology",
            "state": "VA",
            "license": "0101102580",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Gillian Aiello
• May A.C. Anderson, FNP-C
• Kate A Bowman
• Angela K Brittle, RPH
• Erin Burke, PHARMD
• Andrew T Cecil, PT, DPT
• Corry Allen Chapman

• Otolaryngology Physician in Elkton, VA
• Providers in Elkton, VA by specialty
• Otolaryngology Physician in Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 2, 2025; 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.