NPIMap

Individual provider Active NPI

Richard T Bergstrom, M.D.

  • Otolaryngology Physician
  • Redding, CA
National Provider Identifier
1679557367
Registry record updated Sep 5, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Otolaryngology PhysicianTaxonomy code 207Y00000X
License
A80467 Issued in CA
Practice address
3305 Placer St
Ste a
Redding, CA 96001-2364
Phone
(530) 243-3687
Fax
(530) 243-3383
NPI assigned
Dec 6, 2005
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Sep 5, 2012

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Otolaryngology Physician 207Y00000X A80467 CA Primary

Addresses

Primary practice location

3305 Placer St
Ste a
Redding, CA 96001-2364

Mailing address

3305 Placer St
Ste a
Redding, CA 96001-2364
Phone (530) 243-3687

Other identifiers 1

IdentifierTypeStateIssuer
00A804670MedicaidCA

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA
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
I20031119001006 CA Practitioner - Otolaryngology 5496659732 Practice locations: Redding, CA

Care Compare profile

Medicare Care Compare
Specialty
Otolaryngology
Education
Loyola University of Chicago, Stritch School of Medicine, 1997
Medicare assignment
Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

3305 Placer St
Suite a
Redding, CA 96001-2374
Phone (530) 243-3687

Hospital & facility affiliations

  • Mercy Medical Center Redding Hospital, Redding, CA, CCN 050280
  • St Elizabeth Community Hospital Hospital, Red Bluff, CA, CCN 050042
  • Shasta Regional Medical Center Hospital, Redding, CA, CCN 050764
  • Oroville Hospital Hospital, Oroville, CA, CCN 050030
  • Mayers Memorial Hospital Hospital, Fall River Mills, CA, CCN 051305

Merit-based Incentive Payment System (MIPS)

Final score
91.65 of 100Reported as individual
Quality
83.3
Improvement activities
40

Procedures performed for Medicare patients

ProcedureNumber of procedures
Melanoma (skin cancer) excision155
Skin biopsy49

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
A80467CAMDOtolaryngology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Dignity Health Past Accepting new patients
The Cardiovascular Surgical Center Inc. Past Accepting new patients
Redding ENT-Head and Neck Surgery Inc a Medical Group Otolaryngology Past Accepting new patients

Interoperability endpoints

  • Direct secure messaging: bergstrom_richard@251f32ce.micromddirect.com

Organizations & group practices 3

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 6

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": "1133827200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1346803200000",
    "number": "1679557367",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3305 PLACER ST",
            "address_2": "STE A",
            "city": "REDDING",
            "state": "CA",
            "postal_code": "960012364",
            "telephone_number": "530-243-3687",
            "fax_number": "530-243-3383"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3305 PLACER ST",
            "address_2": "STE A",
            "city": "REDDING",
            "state": "CA",
            "postal_code": "960012364",
            "telephone_number": "530-243-3687",
            "fax_number": "530-243-3383"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BERGSTROM",
        "first_name": "RICHARD",
        "middle_name": "T",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2005-12-06",
        "last_updated": "2012-09-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Y00000X",
            "taxonomy_group": "",
            "desc": "Otolaryngology",
            "state": "CA",
            "license": "A80467",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00A804670",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Redding, CA

Sources for this page

Verify at the official NPI Registry.