NPIMap

Individual provider Active NPI

Egerton K Van Den Berg Jr., M.D.

  • Cardiovascular Disease Physician
  • Orlando, FL
National Provider Identifier
1821192501
Registry record updated Sep 12, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Cardiovascular Disease PhysicianTaxonomy code 207RC0000X
License
ME54054 Issued in FL
Practice address
2320 N Orange Ave
Orlando, FL 32804-5506
Phone
(407) 896-0054
Fax
(407) 898-4463
NPI assigned
Sep 12, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 12, 2019

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X 117611 TX
Interventional Cardiology Physician 207RI0011X 117611 VA
Cardiovascular Disease Physician 207RC0000X ME54054 FL Primary

Addresses

Primary practice location

2320 N Orange Ave
Orlando, FL 32804-5506

Mailing address

2320 N Orange Ave
Orlando, FL 32804-5506
Phone (407) 896-0054

Other identifiers 1

IdentifierTypeStateIssuer
103555800MedicaidFL

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in FL
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20091217000462 FL Practitioner - Cardiovascular Disease (Cardiology) 8022156637 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Cardiovascular Disease (Cardiology)
Education
Duke University School of Medicine, 1981
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Orlando Health Medical Group IncGroup PAC ID 9537059084, 2,171 clinicians

Practice addresses (Care Compare)

2320 N Orange Ave
Orlando, FL 32804-5506
Phone (407) 896-0054

Hospital & facility affiliations

  • Orlando Health Hospital, Orlando, FL, CCN 100006
  • Adventhealth Waterman Hospital, Tavares, FL, CCN 100057
  • Adventhealth Sebring Hospital, Sebring, FL, CCN 100109
  • Adventhealth Orlando Hospital, Orlando, FL, CCN 100007
  • Orlando Health South Lake Hospital Hospital, Clermont, FL, CCN 100051

Merit-based Incentive Payment System (MIPS)

Final score
79.91 of 100Reported as group
Quality
61.18
Promoting interoperability
100
Improvement activities
40
Cost
71.86

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
117611TXMDClinical Social Worker
117611VAMDInterventional Cardiology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Orlando Health, Inc. Current Accepting new patients
Orlando Health Medical Group Inc Internal Medicine CurrentSince Jun 1, 2019 Accepting new patients
Orlando Health Medical Group Inc CurrentSince Jun 1, 2019 Accepting new patients
Cardiology Consultants,P.a. Cardiovascular Disease Past Accepting new patients

Locations

3102 Kurt St
Eustis, FL 32726
Phone (352) 357-0055

2320 N Orange Ave
Orlando, FL 32804
Phone (304) 896-0054

32 W Gore St
Orlando, FL 32806
Phone (321) 841-3820

4150 US Highway 27 S
Sebring, FL 33870
Phone (863) 386-0054

Networks

  • Freedom Health HMO Network
  • Optimum HealthCare HMO Network

Interoperability endpoints

  • Direct secure messaging: evandenberg33157@orlandohealth.medalliesdirect.net

Organizations & group practices 4

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.

Hospital & facility affiliations 6

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1158019200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1568246400000",
    "number": "1821192501",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2320 N ORANGE AVE",
            "city": "ORLANDO",
            "state": "FL",
            "postal_code": "328045506",
            "telephone_number": "407-896-0054",
            "fax_number": "407-898-4463"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2320 N ORANGE AVE",
            "city": "ORLANDO",
            "state": "FL",
            "postal_code": "328045506",
            "telephone_number": "407-896-0054",
            "fax_number": "407-898-4463"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "VAN DEN BERG",
        "first_name": "EGERTON",
        "middle_name": "K",
        "name_suffix": "Jr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-09-12",
        "last_updated": "2019-09-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "TX",
            "license": "117611",
            "primary": false
        },
        {
            "code": "207RI0011X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Interventional Cardiology",
            "state": "VA",
            "license": "117611",
            "primary": false
        },
        {
            "code": "207RC0000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Cardiovascular Disease",
            "state": "FL",
            "license": "ME54054",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "103555800",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Orlando, FL

Sources for this page

Verify at the official NPI Registry.