Active NPI
Matthew Bergren
- Speech-Language Pathologist
- Fargo, ND
National Provider Identifier
1710626502
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Speech-Language Pathologist
- License
- 2106
- Practice address
- 825 28TH St S Ste B
Fargo, ND 58103-2325 - Phone
- (701) 356-7766
- Fax
- (701) 356-7765
- NPI assigned
- Jun 1, 2022
- Sex
- Male
- 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 |
|---|---|---|---|---|
| Speech-Language Pathologist | 235Z00000X | 2106 | ND | Primary |
Addresses
Primary practice location
825 28TH St S Ste B
Fargo, ND 58103-2325
Mailing address
825 28TH St S Ste B
Fargo, ND 58103-2325
Phone (701) 356-7766
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in ND
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20221103001701 | ND | Practitioner - Qualified Speech Language Pathologist | 7214304286 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1654041600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1654041600000",
"number": "1710626502",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "825 28TH ST S STE B",
"city": "FARGO",
"state": "ND",
"postal_code": "581032325",
"telephone_number": "701-356-7766",
"fax_number": "701-356-7765"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "825 28TH ST S STE B",
"city": "FARGO",
"state": "ND",
"postal_code": "581032325",
"telephone_number": "701-356-7766",
"fax_number": "701-356-7765"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BERGREN",
"first_name": "MATTHEW",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2022-06-01",
"last_updated": "2022-06-01",
"certification_date": "2022-06-01",
"status": "A"
},
"taxonomies": [
{
"code": "235Z00000X",
"taxonomy_group": "",
"desc": "Speech-Language Pathologist",
"state": "ND",
"license": "2106",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Fargo, ND
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 1, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.