Lisa Y Bergmark, PAC
Individual provider Active NPI Physician Assistant · Brewer, ME
NPI 1740439611 · NPPES record last updated May 4, 2021
Key facts
- NPI
- 1740439611
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Physician Assistant 363A00000X
- License
- PA1434 (ME)
- Practice address
- 735 Wilson St
Brewer, ME 04412-1000 - Phone
- (207) 989-1567
- Fax
- (207) 989-2287
- NPI assigned
- Sep 15, 2008
- Sex
- Female
- Sole proprietor
- Yes
Organizations & group practices 18
Medicare Care Compare profile
- Specialty
- Physician Assistant
- Education
- Other, 2007
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- Penobscot Community Health Center
Practice addresses (Care Compare)
1012 Union St
Bangor, ME 04401-3058
1068 Union St
Bangor, ME 04401-3016
Phone (207) 404-8181
992 Union St
Bangor, ME 04401-3057
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in ME
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: No
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20140131000926 | ME | Practitioner - Physician Assistant | 5799825204 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Physician Assistant
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PA1434 | ME | MD | Physician Assistant |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Penobscot Community Health Center | Current |
Accepting new patients | |
| Penobscot Community Health Center | Current |
Accepting new patients | |
| Henderson County Hospital Corporation | Past | Accepting new patients | |
| Raleigh Durham Medical Group PA | Past |
Accepting new patients | |
| Penobscot Community Health Center | Past | Accepting new patients | |
| Blue Sky, MD PC | Past | Accepting new patients |
Locations
6 Telcom Dr
Bangor, ME 04401
Phone (207) 941-2850
1012 Union St
Ste 1
Bangor, ME 04401
Phone 2079455247407
6 Telcom Dr
Fl 2
Bangor, ME 04401
Phone (207) 947-0147
1012 Union St
Ste 3
Bangor, ME 04401
Phone (207) 404-8040
735 Wilson St
Brewer, ME 04412
Phone (207) 989-1567
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physician Assistant | 363A00000X | PA1434 | ME | Yes |
Addresses
Primary practice location
735 Wilson St
Brewer, ME 04412-1000
Mailing address
PO Box 1599
Bangor, ME 04402-1599
Phone (207) 404-8200
Other providers in Brewer, ME
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on May 4, 2021. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.