Christoph Alexander Bergmann, M.D.

Key facts

NPI

1699717439

Entity type

Individual (NPI type 1)

Primary specialty

Diagnostic Radiology Physician 2085R0202X

License

16289 (MS)

Practice address

4934 Pecan Dr
Belden, MS 38826-8715

Phone

(662) 840-1708

NPI assigned

Jun 12, 2006

Sex

Male

Sole proprietor

Yes

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.

• Mississippi Medical Imaging Group, PLLC Diagnostic Radiology Physician · Belden, MS · NPI 1447680798
  NPD (past) Authorized official DIAGNOSTIC RADIOLOGY
• Amory Primary Medicine Clinic Internal Medicine Physician · Amory, MS · NPI 1417170721
  NPD (past)
• Premier Radiology, Inc Diagnostic Radiology Physician · Tupelo, MS · NPI 1083669121
  NPD (past) DIAGNOSTIC RADIOLOGY

Medicare participation

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

National Provider Directory

Medicare enrollment (NPD)

Yes

Credentials

Doctor of Medicine

State licenses

Practice roles

Specialties & licenses

Addresses

Other identifiers

The complete NPPES record for this NPI in the NPI Registry API JSON format, last updated by the provider on Nov 14, 2013.

{
    "created_epoch": "1150070400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1384387200000",
    "number": "1699717439",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4934 PECAN DR",
            "city": "BELDEN",
            "state": "MS",
            "postal_code": "388268715",
            "telephone_number": "662-840-1708"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4934 PECAN DR",
            "city": "BELDEN",
            "state": "MS",
            "postal_code": "388268715",
            "telephone_number": "662-840-1708"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BERGMANN",
        "first_name": "CHRISTOPH",
        "middle_name": "ALEXANDER",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-06-12",
        "last_updated": "2013-11-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2085R0202X",
            "taxonomy_group": "",
            "desc": "Radiology, Diagnostic Radiology",
            "state": "MS",
            "license": "16289",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00120594",
            "state": "MS"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "009908720",
            "state": "AL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "300096927",
            "state": "MS"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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All providers in Belden, MS · Diagnostic Radiology Physician in Mississippi