Thomas M Bergren, DO

Primary specialty

Internal Medicine PhysicianTaxonomy code 207R00000X

License

DO2846 Issued in NV

Practice address

3131 La Canada St Ste 200
Las Vegas, NV 89169-2579

Phone

(702) 369-5582

Fax

(702) 650-5148

NPI assigned

Oct 12, 2017

Last updated

Aug 17, 2023By the provider in NPPES

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Enrolled in NV

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

Specialty

Internal Medicine

Education

Michigan State University College of Osteopathic Medicine, 2017

Medicare assignment

May accept Medicare assignment

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Osteopathy

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: thomas.bergren.1@29601.direct.athenahealth.com
• Direct secure messaging: thomas.bergren@centerwell.eclinicaldirectplus.com

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.

• Intermountain Medical Holdings Nevada Inc

  dba Intermountain Health

  • Internal Medicine Physician
  • Henderson, NV
  • NPI 1245997279
  Medicare reassignment NPD
• Centerwell Senior Primary Care NV P C

  dba CenterWell Senior Primary Care-Spring Valley

  • Internal Medicine Physician
  • Las Vegas, NV
  • NPI 1285257667
  Medicare reassignment
• Centerwell Senior Primary Care (NV) PC

  dba CenterWell Senior Primary Care-Green Valley

  • Internal Medicine Physician
  • Las Vegas, NV
  • NPI 1053029488
  NPD
• Centerwell Senior Primary Care (NV) PC

  dba CenterWell Senior Primary Care-West Craig

  • Internal Medicine Physician
  • Las Vegas, NV
  • NPI 1255954640
  NPD
• Healthcare Partners Medical Group Coats LTD

  • Family Medicine Physician
  • Las Vegas, NV
  • NPI 1487631917

  Internal Medicine

  NPD
• Intermountain Medical Holdings Nevada Inc

  dba Intermountain Health Home Care

  • Home Health Agency
  • Las Vegas, NV
  • NPI 1689882557
  NPD
• Centerwell Senior Primary Care (NV) PC

  dba CenterWell Senior Primary Care -Fremont Street

  • Internal Medicine Physician
  • Las Vegas, NV
  • NPI 1083237465
  NPD (past)
• Centerwell Senior Primary Care NV P C

  • Internal Medicine Physician
  • Miami, FL
  • NPI 1104449560
  NPD (past)

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

{
    "created_epoch": "1507766400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1692230400000",
    "number": "1770094153",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6355 S BUFFALO DR FL 3",
            "city": "LAS VEGAS",
            "state": "NV",
            "postal_code": "891132133",
            "telephone_number": "702-216-3346",
            "fax_number": "702-671-6883"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3131 LA CANADA ST STE 200",
            "city": "LAS VEGAS",
            "state": "NV",
            "postal_code": "891692579",
            "telephone_number": "702-369-5582",
            "fax_number": "702-650-5148"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "110 E Allegan St Apt 1",
            "address_purpose": "LOCATION",
            "city": "Lansing",
            "state": "MI",
            "postal_code": "489331852",
            "country_code": "US",
            "telephone_number": "586-925-9519",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "BERGREN",
        "first_name": "THOMAS",
        "middle_name": "M",
        "name_prefix": "Dr.",
        "credential": "DO",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2017-10-12",
        "last_updated": "2023-08-17",
        "certification_date": "2023-08-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "MI",
            "license": "5101023688",
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "NV",
            "license": "DO2846",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1770094153",
            "state": "NV"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "STATE LICENSE",
            "identifier": "DO2846",
            "state": "NV"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Kelsey Esther Bergey, LPMT, MMT, MT-BC
• Natalie Bergl, BSW
• Kristina L Berglund
• Caridad Bergolla Alvarez
• Kathleen Leilani Bergquist, , MSW, LCSW, PH.D.
• Kimberly Bergstrom
• Nurayni Berhan
• Naomi Berhane
• Bethel Berhanu
• Roza Berhanu

• Internal Medicine Physician in Las Vegas, NV
• Providers in Las Vegas, NV by specialty
• Internal Medicine Physician in Nevada

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 17, 2023; 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.