Kimberly Anne Berggren, PA-C

Primary specialty

Physician AssistantTaxonomy code 363A00000X

Practice address

96TH Medical Group
307 Boatner Rd, Suite 114
Eglin AFB, FL 32542-1282

Phone

(508) 838-1328

Fax

(850) 862-4423

NPI assigned

Jun 10, 2008

Last updated

Jun 24, 2024By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other names 1

• Kimberly Anne Nielsen Former name

Medicare fee-for-service enrollment

Enrolled in FL

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Physician Assistant

Education

Eastern Virginia Medical School, 2004

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Stephen Mosley PA-C LLCGroup PAC ID 2668862293, 3 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

Practice roles

Interoperability endpoints

• Direct secure messaging: kimberlyberggren@ocfl.allscriptsdirect.net

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.

• Stephen Mosley PA-C LLC

  • Physician Assistant
  • Santa Rosa Beach, FL
  • NPI 1083379366
  Medicare reassignment Care Compare group NPD
• Gulf Emergency Specialists PA

  • Emergency Medicine Physician
  • Panama City, FL
  • NPI 1770521759
  NPD (past)
• Trout Lake Inpatient Services, LLC

  • Hospitalist Physician
  • Niceville, FL
  • NPI 1780026542
  NPD (past)
• Vale of Paradise Emergency Physicians, LLC

  • Emergency Medicine Physician
  • Niceville, FL
  • NPI 1831522614
  NPD (past)
• Affilion LLC

  • Emergency Medical Services (Emergency Medicine) Physician
  • Las Cruces, NM
  • NPI 1720291529
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1213056000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1719187200000",
    "number": "1730349242",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9TH MEDICAL GROUP",
            "address_2": "307 BOATNER RD, STE 114",
            "city": "EGLIN AFB",
            "state": "FL",
            "postal_code": "325421282",
            "telephone_number": "850-883-8132"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "96TH MEDICAL GROUP",
            "address_2": "307 BOATNER RD, SUITE 114",
            "city": "EGLIN AFB",
            "state": "FL",
            "postal_code": "325421282",
            "telephone_number": "508-838-1328",
            "fax_number": "850-862-4423"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BERGGREN",
        "first_name": "KIMBERLY",
        "middle_name": "ANNE",
        "name_prefix": "Mrs.",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2008-06-10",
        "last_updated": "2024-06-24",
        "certification_date": "2024-06-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "FL",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "KIMBERLY",
            "last_name": "NIELSEN",
            "middle_name": "ANNE",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Mark Bazemore
• Brooke Marie Bell, M.D.
• Trisha Benish, PHYSICIAN ASSISTANT
• Travis W Bennett, DMD
• Ryan Bennion, DO
• Sapna Bhatia, MD
• Desmond John Biava, PA-C
• Russell David Bienias, D.M.D
• Stephen Thomas Biggs, IDMT
• Bradie N Bishop, M.D.

• Physician Assistant in Eglin AFB, FL
• Providers in Eglin AFB, FL by specialty
• Physician Assistant in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 24, 2024; 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.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.