Andrew Evo Bertagna, DMD, MD

Primary specialty

Oral and Maxillofacial Surgery (Dentist)Taxonomy code 1223S0112X

License

019032240 Issued in IL

Practice address

605 Courtyard Dr
St Charles, IL 60174-1463

Phone

(630) 377-7077

NPI assigned

Jun 17, 2019

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

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

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.

Opted out of Medicare

Yes, effective Aug 20, 2025 through Aug 20, 2027

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: abertagna18561@uihealth.direct-ci.com

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.

• Mgm19 Inc

  • Oral and Maxillofacial Surgery (Dentist)
  • Saint Charles, IL
  • NPI 1215579008
  NPD

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

{
    "created_epoch": "1560729600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1750636800000",
    "number": "1790345262",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "825 SEERS DR",
            "city": "SCHAUMBURG",
            "state": "IL",
            "postal_code": "601736198"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "605 COURTYARD DR",
            "city": "ST CHARLES",
            "state": "IL",
            "postal_code": "601741463",
            "telephone_number": "630-377-7077"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BERTAGNA",
        "first_name": "ANDREW",
        "middle_name": "EVO",
        "name_prefix": "Dr.",
        "credential": "DMD, MD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2019-06-17",
        "last_updated": "2025-06-23",
        "certification_date": "2025-06-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "IL",
            "license": "019032240",
            "primary": false
        },
        {
            "code": "1223S0112X",
            "taxonomy_group": "",
            "desc": "Dentist, Oral and Maxillofacial Surgery",
            "state": "IL",
            "license": "019032240",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Jennifer Berg
• Robert Berg
• Sue Bergstrom
• Autumn E Bernicky, DO
• Kimberly Berry
• Charles E. W. Berthold, PH.D.
• Brenda Lee Bertrand, RN
• Cecilia Berumen, APRN FPA
• Best Practices Inpatient Care, LTD.
• Eric Baldric Bettag, DPM

• Oral and Maxillofacial Surgery (Dentist) in St Charles, IL
• Providers in St Charles, IL by specialty
• Oral and Maxillofacial Surgery (Dentist) in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 23, 2025; 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; Opt Out Affidavits.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.