Russell Alan Bergum, D.O.

Primary specialty

Sports Medicine (Family Medicine) PhysicianTaxonomy code 207QS0010X

License

42602 Issued in MN

Practice address

2560 2ND St SW Ste 120
Rochester, MN 55902-4363

Phone

(507) 361-0400

Fax

(866) 371-6710

NPI assigned

Jun 28, 2006

Last updated

Aug 16, 2023By 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 1

Addresses

Medicare fee-for-service enrollment

Enrolled in IA

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

Family Practice

Education

Other, 1999

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Osteopathy, Doctor of Medicine

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: russdoc@iosrochester.emadirect.md

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.

• Harbor View Medical Services LLC

  dba Regenexx Des Moines

  • Sports Medicine (Physical Medicine & Rehabilitation) Physician
  • Des Moines, IA
  • NPI 1194108209
  Medicare reassignment NPD
• Interventional Orthopedic Solutions-Rochester, PLLC

  dba IOS-Rochester

  • Sports Medicine (Family Medicine) Physician
  • Rochester, MN
  • NPI 1457005084
  NPD Authorized official
• Mayo Clinic

  • Clinical Medical Laboratory
  • Rochester, MN
  • NPI 1083249577
  NPD (past)

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

{
    "created_epoch": "1151452800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1692144000000",
    "number": "1669400024",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2560 2ND ST SW STE 120",
            "city": "ROCHESTER",
            "state": "MN",
            "postal_code": "559024363",
            "telephone_number": "507-361-0400",
            "fax_number": "866-371-6710"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2560 2ND ST SW STE 120",
            "city": "ROCHESTER",
            "state": "MN",
            "postal_code": "559024363",
            "telephone_number": "507-361-0400",
            "fax_number": "866-371-6710"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "6151 Thornton Ave Ste 200",
            "address_purpose": "LOCATION",
            "city": "Des Moines",
            "state": "IA",
            "postal_code": "503212413",
            "country_code": "US",
            "telephone_number": "515-421-4090",
            "fax_number": "402-939-0407",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "BERGUM",
        "first_name": "RUSSELL",
        "middle_name": "ALAN",
        "credential": "D.O.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-06-28",
        "last_updated": "2023-08-16",
        "certification_date": "2023-08-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207QS0010X",
            "taxonomy_group": "",
            "desc": "Family Medicine, Sports Medicine",
            "state": "MN",
            "license": "42602",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Thomas R Bergman, PA-C
• Jay D Bergner, RN, CRNA
• Thomas Bergquist, PHD
• Beth A Bergstedt, LICSW
• Jennifer Lynn Bergstrom, OT
• Beteliham S Berhane, PHARM.D.
• Hannah Daothip Berhow, DO
• Sarah Elizabeth Berini
• Grace Berke, RN
• Camilo Bermudez Noguera, MD, PHD

• Sports Medicine (Family Medicine) Physician in Rochester, MN
• Providers in Rochester, MN by specialty
• Sports Medicine (Family Medicine) Physician in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 16, 2023; 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.