Active NPI
Tadd William Berg
- Athletic Trainer
- Fort Polk, LA
National Provider Identifier
1851906697
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Athletic Trainer
- License
- 3277
- Practice address
- 2030 14TH St BLDG 1830
Fort Polk, LA 71459-5302 - Phone
- (337) 718-2913
- NPI assigned
- Sep 9, 2020
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Athletic Trainer | 2255A2300X | 3277 | TN | Primary |
Addresses
Primary practice location
2030 14TH St BLDG 1830
Fort Polk, LA 71459-5302
Mailing address
7910 Destiny Blvd
Fort Campbell, KY 42223
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 3277 | TN | MD | Athletic Trainer |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1599609600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1763337600000",
"number": "1851906697",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "7910 DESTINY BLVD",
"city": "FORT CAMPBELL",
"state": "KY",
"postal_code": "42223"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2030 14TH ST BLDG 1830",
"city": "FORT POLK",
"state": "LA",
"postal_code": "714595302",
"telephone_number": "337-718-2913"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BERG",
"first_name": "TADD",
"middle_name": "WILLIAM",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2020-09-09",
"last_updated": "2025-11-17",
"certification_date": "2025-11-17",
"status": "A"
},
"taxonomies": [
{
"code": "2255A2300X",
"taxonomy_group": "193400000X SINGLE SPECIALTY GROUP",
"desc": "Specialist/Technologist, Athletic Trainer",
"state": "TN",
"license": "3277",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Fort Polk, LA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 17, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.