Active NPI
Roberta L Berg, MD
- Family Medicine Physician
- Santa Rosa, CA
National Provider Identifier
1689643884
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Medicine Physician
- License
- G18770
- Practice address
- 144 Stony Point Road
Sonoma County Indian Health Project
Santa Rosa, CA 95401 - Phone
- (707) 521-4500
- Fax
- (707) 544-4626
- NPI assigned
- Mar 17, 2006
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | G18770 | CA | Primary |
Addresses
Primary practice location
144 Stony Point Road
Sonoma County Indian Health Project
Santa Rosa, CA 95401
Mailing address
144 Stony Point Road
Sonoma County Indian Health Project
Santa Rosa, CA 95401
Phone (707) 521-4500
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 00G187700 | Medicaid | CA |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Eligible to order & refer
- Part B services: No
- Medical equipment: Yes
- Home health: No
- Power mobility devices: Yes
- Hospice: No
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Sonoma County Indian Health Project, Inc | Family Medicine | Past | Accepting new patients |
Interoperability endpoints
- rberg663988@direct.ochin.org
Organizations & group practices 1
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.
-
- Federally Qualified Health Center (FQHC)
- Santa Rosa, CA
- NPI 1265457980
Family Medicine
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1142553600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1318204800000",
"number": "1689643884",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "144 STONY POINT ROAD",
"address_2": "SONOMA COUNTY INDIAN HEALTH PROJECT",
"city": "SANTA ROSA",
"state": "CA",
"postal_code": "95401",
"telephone_number": "707-521-4500",
"fax_number": "707-544-4626"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "144 STONY POINT ROAD",
"address_2": "SONOMA COUNTY INDIAN HEALTH PROJECT",
"city": "SANTA ROSA",
"state": "CA",
"postal_code": "95401",
"telephone_number": "707-521-4500",
"fax_number": "707-544-4626"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BERG",
"first_name": "ROBERTA",
"middle_name": "L",
"name_prefix": "Dr.",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-03-17",
"last_updated": "2011-10-10",
"status": "A"
},
"taxonomies": [
{
"code": "207Q00000X",
"taxonomy_group": "",
"desc": "Family Medicine",
"state": "CA",
"license": "G18770",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "00G187700",
"state": "CA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Santa Rosa, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 10, 2011; 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.