NPIMap

Individual provider Active NPI

Lynn Marie Bergren, D.O.

  • Diagnostic Radiology Physician
  • Portsmouth, VA
National Provider Identifier
1669446134
Registry record updated Feb 6, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Diagnostic Radiology PhysicianTaxonomy code 2085R0202X
License
0102201409 Issued in VA
Practice address
620 John Paul Jones Cir
Naval Medical Center
Portsmouth, VA 23708-2111
Phone
(757) 953-1204
Fax
(757) 953-0805
NPI assigned
Feb 14, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 6, 2024

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

Specialties & licenses 5

Specialty (taxonomy)CodeLicenseStatePrimary
Diagnostic Radiology Physician 2085R0202X 02002490A IN
Diagnostic Radiology Physician 2085R0202X 051911 GA
Diagnostic Radiology Physician 2085R0202X 76071 MN
Diagnostic Radiology Physician 2085R0202X 5101012233 MI
Diagnostic Radiology Physician 2085R0202X 0102201409 VA Primary

Addresses

Primary practice location

620 John Paul Jones Cir
Naval Medical Center
Portsmouth, VA 23708-2111

Mailing address

620 John Paul Jones Cir
Naval Medical Center
Portsmouth, VA 23708-2111
Phone (757) 953-1204

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MN
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20240305001769 MN Practitioner - Diagnostic Radiology 9335032408 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Diagnostic Radiology
Education
Other, 1992
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
The Duluth Clinic LTDGroup PAC ID 2567374283, 1,135 clinicians

Practice addresses (Care Compare)

420 E 1St St
Duluth, MN 55805-1901
Phone (218) 786-8364

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
051911GAMDDiagnostic Radiology Physician
02002490AINMDDiagnostic Radiology Physician
5101012233MIMDDiagnostic Radiology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
The Duluth Clinic LTD Current Accepting new patients
The Duluth Clinic LTD CurrentSince Feb 26, 2023 Accepting new patients
The Duluth Clinic, LTD. CurrentSince Feb 26, 2023 Accepting new patients
American Radiology Associates, P.a. Diagnostic Radiology Past Accepting new patients
Premier Radiology Associates, Inc. Diagnostic Radiology Past Accepting new patients
University of Virginia Physicians Group PastSince Nov 1, 2017 Accepting new patients
American Radiology Associates, P.a. Diagnostic Radiology Past Accepting new patients
Quantum Medical Radiology of California, P.C. Diagnostic Radiology Past Accepting new patients
Pulaski Radiologists LLC Diagnostic Radiology Past Accepting new patients

Locations

420 E 1st St
Duluth, MN 55805
Phone (218) 786-1265

400 E 3rd St
Duluth, MN 55805
Phone (218) 722-8364

Organizations & group practices 9

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.

Hospital & facility affiliations 8

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1139875200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1707177600000",
    "number": "1669446134",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "620 JOHN PAUL JONES CIR",
            "address_2": "NAVAL MEDICAL CENTER",
            "city": "PORTSMOUTH",
            "state": "VA",
            "postal_code": "237082111",
            "telephone_number": "757-953-1204",
            "fax_number": "757-953-0805"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "620 JOHN PAUL JONES CIR",
            "address_2": "NAVAL MEDICAL CENTER",
            "city": "PORTSMOUTH",
            "state": "VA",
            "postal_code": "237082111",
            "telephone_number": "757-953-1204",
            "fax_number": "757-953-0805"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BERGREN",
        "first_name": "LYNN",
        "middle_name": "MARIE",
        "name_prefix": "Dr.",
        "credential": "D.O.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-02-14",
        "last_updated": "2024-02-06",
        "certification_date": "2024-02-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2085R0202X",
            "taxonomy_group": "",
            "desc": "Radiology, Diagnostic Radiology",
            "state": "IN",
            "license": "02002490A",
            "primary": false
        },
        {
            "code": "2085R0202X",
            "taxonomy_group": "",
            "desc": "Radiology, Diagnostic Radiology",
            "state": "GA",
            "license": "051911",
            "primary": false
        },
        {
            "code": "2085R0202X",
            "taxonomy_group": "",
            "desc": "Radiology, Diagnostic Radiology",
            "state": "MN",
            "license": "76071",
            "primary": false
        },
        {
            "code": "2085R0202X",
            "taxonomy_group": "",
            "desc": "Radiology, Diagnostic Radiology",
            "state": "MI",
            "license": "5101012233",
            "primary": false
        },
        {
            "code": "2085R0202X",
            "taxonomy_group": "",
            "desc": "Radiology, Diagnostic Radiology",
            "state": "VA",
            "license": "0102201409",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Portsmouth, VA

Sources for this page

Verify at the official NPI Registry.