NPIMap

Individual provider Active NPI

Becquie Berck, PA

  • Medical Physician Assistant
  • La Plata, MD
National Provider Identifier
1679833206
Registry record updated Nov 5, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Medical Physician AssistantTaxonomy code 363AM0700X
License
PA21082 Issued in CA
Practice address
5 Garrett Ave
La Plata, MD 20646-5960
Phone
(301) 609-4715
NPI assigned
May 16, 2012
Last updated
Nov 5, 2018By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 5, 2018

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Medical Physician Assistant 363AM0700X PA21082 CA Primary

Addresses

Primary practice location

5 Garrett Ave
La Plata, MD 20646-5960

Mailing address

5 Garrett Ave
La Plata, MD 20646-5960

Other practice location 1

865 Patriot Dr
Suite 102
Moorpark, CA 93021-3407
Phone (805) 532-2032

Other names 1

  • Becquie Berck Other name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA, VA2 enrollments
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20160920002560 CA Practitioner - Physician Assistant 4789971672 Reassigns benefits to 4 organizations
I20250424003028 VA Practitioner - Physician Assistant 4789971672 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 1991
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

14540 Mono Way
Sonora, CA 95370-8858
Phone (209) 536-6680

23 N Main St
Suite 101
Angels Camp, CA 95222-8001
Phone (209) 736-9130

729 Pauline Court
Sonora, CA 95370
Phone (209) 588-8068

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

State licenses

LicenseStateTypeSpecialty
PA21082CAMDMedical Physician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Adventist Health Physicians Network CurrentSince Dec 1, 2023 Accepting new patients
Sonora Community Hospital CurrentSince Sep 6, 2023 Accepting new patients
Adventist Health Physicians Network CurrentSince Dec 1, 2023 Accepting new patients
Sonora Community Hospital CurrentSince Sep 6, 2023 Accepting new patients
Adventist Health Heart Institute-Ukiah Past Accepting new patients

Locations

1000 Greenley Rd
Sonora, CA 95370
Phone (209) 263-0803

14540 State Highway 108
Sonora, CA 95370
Phone (209) 532-3167

Organizations & group practices 10

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.

Hospital & facility affiliations 12

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": "1337126400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1541376000000",
    "number": "1679833206",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5 GARRETT AVE",
            "city": "LA PLATA",
            "state": "MD",
            "postal_code": "206465960"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5 GARRETT AVE",
            "city": "LA PLATA",
            "state": "MD",
            "postal_code": "206465960",
            "telephone_number": "301-609-4715"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "865 Patriot Dr",
            "address_2": "Suite 102",
            "address_purpose": "LOCATION",
            "city": "Moorpark",
            "state": "CA",
            "postal_code": "930213407",
            "country_code": "US",
            "telephone_number": "805-532-2032",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "BERCK",
        "first_name": "BECQUIE",
        "name_prefix": "Ms.",
        "credential": "PA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2012-05-16",
        "last_updated": "2018-11-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "CA",
            "license": "PA21082",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "BECQUIE",
            "last_name": "BERCK",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in La Plata, MD

Sources for this page

Verify at the official NPI Registry.