Timothy Stephan Berger, D.M.D.

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

12008676 Issued in IN

Practice address

1620 Saint Joe River Dr
Fort Wayne, IN 46805-1434

Phone

(260) 482-4202

Fax

(260) 482-5232

NPI assigned

Jun 8, 2006

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in IN

Eligible to order & refer

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

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

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.

• Dr Timothy Berger

  • Dentist
  • Fort Wayne, IN
  • NPI 1114212461
  NPD (past) Authorized official

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

{
    "created_epoch": "1149724800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1790725489",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1620 SAINT JOE RIVER DR",
            "city": "FORT WAYNE",
            "state": "IN",
            "postal_code": "468051434",
            "telephone_number": "260-482-4202",
            "fax_number": "260-482-5232"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1620 SAINT JOE RIVER DR",
            "city": "FORT WAYNE",
            "state": "IN",
            "postal_code": "468051434",
            "telephone_number": "260-482-4202",
            "fax_number": "260-482-5232"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BERGER",
        "first_name": "TIMOTHY",
        "middle_name": "STEPHAN",
        "name_prefix": "Dr.",
        "credential": "D.M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-06-08",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "IN",
            "license": "12008676",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Michael Richard Berg, CRNA
• Allison Bergdoll, DDS, MS
• Berger Dentistry SW
• Jonathan A Berger, MD
• Suzanne Lisette Berger
• Lisa A Bergeron, M.D.
• Michael H Bergeron, MA, LMHC
• Autumne Berghoff, PA-C
• Greg B Berghoff, RPH
• Lucas Berghoff, D.O.

• General Practice Dentistry in Fort Wayne, IN
• Providers in Fort Wayne, IN by specialty
• General Practice Dentistry in Indiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.