Individual provider Active NPI

Merritt Jonathan Bern, MD

  • Gastroenterology Physician
  • Roanoke, VA
National Provider Identifier
1720066483
Registry record updated Dec 4, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Gastroenterology PhysicianTaxonomy code 207RG0100X
License
01080690A Issued in IN
Practice address
3 Riverside Cir
Carilion Clinic Gastroenterolgy Riverside 3
Roanoke, VA 24016-4955
Phone
(540) 224-5170
Fax
(540) 985-9418
NPI assigned
Jan 4, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 4, 2018

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Gastroenterology Physician 207RG0100X 0101040654 VA
Gastroenterology Physician 207RG0100X 01080690A IN Primary

Addresses

Primary practice location

3 Riverside Cir
Carilion Clinic Gastroenterolgy Riverside 3
Roanoke, VA 24016-4955

Mailing address

3 Riverside Cir
Carilion Clinic Gastroenterolgy Riverside 3
Roanoke, VA 24016-4955
Phone (540) 224-5170

Other practice location 1

11104 Parkview Circle Dr Ste 310
Fort Wayne, IN 46845-1733
Phone (260) 266-5230

Other identifiers 4

IdentifierTypeStateIssuer
VVA900AOtherVAMEDICARE PTAN
100009137OtherMC RAIL ROAD
006097839MedicaidVA
260856OtherANTHEM

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20190502000490 MI Practitioner - GastroenterologyPractitioner - Internal Medicine 9032205141 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
GastroenterologyAlso: Internal Medicine
Education
University of Miami, LM Miller School of Medicine, 1982
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
W. a. Foote Memorial Hospital, Inc.Group PAC ID 0244136067, 476 clinicians

Practice addresses (Care Compare)

744 W Michigan Ave
201 Henry Ford Allegiance Gastroenterology
Jackson, MI 49201-1900
Phone (517) 205-7618

Hospital & facility affiliations

  • Henry Ford Allegiance Health Hospital, Jackson, MI, CCN 230092

Procedures performed for Medicare patients

ProcedureNumber of procedures
Colonoscopy110
Upper gastrointestinal (GI) endoscopy for acid reflux172

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
0101040654VAMDGastroenterology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
W.a. Foote Memorial Hospital, Inc CurrentSince Mar 1, 2019 Accepting new patients
W.a. Foote Memorial Hospital, Inc Gastroenterology CurrentSince Mar 1, 2019 Accepting new patients
W. a. Foote Memorial Hospital, Inc Internal Medicine Current Accepting new patients
Henry Ford Pathology Current Accepting new patients
Wa Foote Memorial Hospital, Inc Past Accepting new patients

Locations

1100 E Michigan Ave
Ste 205
Jackson, MI 49201
Phone (517) 205-7618

205 N East Ave
Jackson, MI 49201
Phone (517) 788-4730

813 W Michigan Ave
Jackson, MI 49202
Phone (517) 205-1000

744 W Michigan Ave
Ste 201
Jackson, MI 49201
Phone (517) 205-7618

Interoperability endpoints

  • Direct secure messaging: mbern564868@direct.hfhs.org

Organizations & group practices 5

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 1

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": "1136332800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1543881600000",
    "number": "1720066483",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3 RIVERSIDE CIR",
            "address_2": "CARILION CLINIC GASTROENTEROLGY RIVERSIDE 3",
            "city": "ROANOKE",
            "state": "VA",
            "postal_code": "240164955",
            "telephone_number": "540-224-5170",
            "fax_number": "540-985-9418"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3 RIVERSIDE CIR",
            "address_2": "CARILION CLINIC GASTROENTEROLGY RIVERSIDE 3",
            "city": "ROANOKE",
            "state": "VA",
            "postal_code": "240164955",
            "telephone_number": "540-224-5170",
            "fax_number": "540-985-9418"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "11104 Parkview Circle Dr Ste 310",
            "address_purpose": "LOCATION",
            "city": "Fort Wayne",
            "state": "IN",
            "postal_code": "468451733",
            "country_code": "US",
            "telephone_number": "260-266-5230",
            "fax_number": "260-266-5238",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "BERN",
        "first_name": "MERRITT",
        "middle_name": "JONATHAN",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-01-04",
        "last_updated": "2018-12-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207RG0100X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Gastroenterology",
            "state": "VA",
            "license": "0101040654",
            "primary": false
        },
        {
            "code": "207RG0100X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Gastroenterology",
            "state": "IN",
            "license": "01080690A",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE PTAN",
            "identifier": "VVA900A",
            "state": "VA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MC RAIL ROAD",
            "identifier": "100009137",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "006097839",
            "state": "VA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ANTHEM",
            "identifier": "260856",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Roanoke, VA

Sources for this page

Verify at the official NPI Registry.