Individual provider Active NPI

Jeffrey Parke Bergeson, O.D.

  • Optometrist
  • Kingman, AZ
National Provider Identifier
1861691586
Registry record updated Jul 12, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
1582 Issued in AZ
Practice address
1925 Florence Ave
Kingman, AZ 86401-4617
Phone
(971) 404-8569
NPI assigned
Jul 12, 2007
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 12, 2007

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Optometrist 152W00000X 1582 AZ Primary

Addresses

Primary practice location

1925 Florence Ave
Kingman, AZ 86401-4617

Mailing address

1925 Florence Ave
Kingman, AZ 86401-4617
Phone (971) 404-8569

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in AZ
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

Enrollment IDStateProvider typePAC IDDetails
I20071016000272 AZ Practitioner - Optometry 4082700455 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Optometry
Education
Pacific University - College of Optometry, 2007
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Mohave Eye Centers LTD.Group PAC ID 7911985247, 9 clinicians

Practice addresses (Care Compare)

2110 Airway Ave
Kingman, AZ 86409-3652
Phone (928) 753-2106

Merit-based Incentive Payment System (MIPS)

Final score
87.57 of 100Reported as individual
Quality
75.14
Improvement activities
40

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
1582AZMDPhysical Therapist

Practice roles

OrganizationSpecialtyStatusNew patients
Mohave Eye Centers LTD Optometrist CurrentSince Jul 23, 2007 Accepting new patients
Mohave Eye Center, LTD Optometrist CurrentSince Jul 23, 2007 Accepting new patients

Locations

3003 Highway 95
Ste 11
Bullhead City, AZ 86442
Phone (928) 763-1000

2110 Airway Ave
Kingman, AZ 86409
Phone (928) 681-1800

1925 Florence Ave
Kingman, AZ 86401
Phone (520) 753-2106

2005 Injo Dr
Ste 102
Lk Havasu Cty, AZ 86403
Phone (928) 505-3696

1680 Willow Creek Rd
Prescott, AZ 86301
Phone (928) 320-2306

Interoperability endpoints

  • Direct secure messaging: jeffrey.bergeson@direct.revolutionehr.com

Organizations & group practices 2

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.

NPI Registry JSON

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

{
    "created_epoch": "1184198400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1184198400000",
    "number": "1861691586",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1925 FLORENCE AVE",
            "city": "KINGMAN",
            "state": "AZ",
            "postal_code": "864014617",
            "telephone_number": "971-404-8569"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1925 FLORENCE AVE",
            "city": "KINGMAN",
            "state": "AZ",
            "postal_code": "864014617",
            "telephone_number": "971-404-8569"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BERGESON",
        "first_name": "JEFFREY",
        "middle_name": "PARKE",
        "credential": "O.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-07-12",
        "last_updated": "2007-07-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "AZ",
            "license": "1582",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Kingman, AZ

Sources for this page

Verify at the official NPI Registry.