Blair Alexander Bergen, MD

Primary specialty

Obstetrics & Gynecology PhysicianTaxonomy code 207V00000X

License

25MA04675800 Issued in NJ

Practice address

2500 English Creek Ave
BLDG 200 Suite214
Egg Harbor Township, NJ 08234-5549

Phone

(609) 677-7211

Fax

(609) 677-7210

NPI assigned

Oct 18, 2006

Last updated

Dec 1, 2008By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in NJ

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.

Enrollment records 1

Specialty

Obstetrics/Gynecology

Education

Rutgers New Jersey Medical School, 1988

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Southern Jersey Family Medical Centers, IncGroup PAC ID 0547170763, 42 clinicians

Atlanticare Physician Group PAGroup PAC ID 8527953660, 506 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Atlanticare Regional Medical Center - City Campus Hospital, Atlantic City, NJ, CCN 310064

Procedures performed for Medicare patients

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

All facility ownership & control disclosures 6

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

Owned or controlled facilities with NPI records 6

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

• Atlanticare Health Services, Inc.

  • Federally Qualified Health Center (FQHC)
  • Atlantic City, NJ
  • NPI 1265200190

  Corporate Officer

  CMS ownership
• Atlanticare Health Services, Inc.

  dba AtlantiCare Health Services - FQHC at Atlantic City High School

  • Federally Qualified Health Center (FQHC)
  • Atlantic City, NJ
  • NPI 1396485074

  Corporate Director

  CMS ownership
• Atlanticare Health Services, Inc.

  dba AtlantiCare Health Services - FQHC

  • Federally Qualified Health Center (FQHC)
  • Atlantic City, NJ
  • NPI 1407574635

  Corporate Director

  CMS ownership
• Atlanticare Health Services, Inc.

  • Federally Qualified Health Center (FQHC)
  • Egg Harbor Township, NJ
  • NPI 1407617947

  Corporate Director

  CMS ownership
• Atlanticare Health Services, Inc.

  dba AtlantiCare Health Services - FQHC

  • Federally Qualified Health Center (FQHC)
  • Atlantic City, NJ
  • NPI 1457089252

  Corporate Director

  CMS ownership
• Atlanticare Health Services, Inc.

  • Federally Qualified Health Center (FQHC)
  • Pleasantville, NJ
  • NPI 1477315885

  Corporate Director

  CMS ownership

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Atlanticare Physician Group PA

  • Clinic/Center
  • Egg Harbor Township, NJ
  • NPI 1093829608

  Obstetrics & Gynecology

  Medicare reassignment Care Compare group NPD
• Southern Jersey Family Medical Centers, Inc

  • Federally Qualified Health Center (FQHC)
  • Hammonton, NJ
  • NPI 1568473973
  Medicare reassignment Care Compare group NPD
• Atlanticare Physician Group, PA

  dba AtlantiCare Urgent Care

  • Urgent Care Clinic/Center
  • Galloway, NJ
  • NPI 1003820622
  NPD
• Southern Jersey Family Medical Centers, Inc

  • Federally Qualified Health Center (FQHC)
  • Burlington City, NJ
  • NPI 1265557326
  NPD
• Atlanticare Physician Group

  dba AtlantiCare Internal Medicine

  • Primary Care Clinic/Center
  • Ventnor City, NJ
  • NPI 1194839910
  NPD (past)
• Atlanticare Regional Medical Center

  • General Acute Care Hospital
  • Pomona, NJ
  • NPI 1013919315
  NPD (past)

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

• Atlanticare Regional Medical Center

  • General Acute Care Hospital
  • Pomona, NJ
  • NPI 1013919315
  Care Compare affiliation

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

{
    "created_epoch": "1161129600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1228089600000",
    "number": "1881775658",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2500 ENGLISH CREEK AVE",
            "address_2": "BLDG 200 SUITE214",
            "city": "EGG HARBOR TOWNSHIP",
            "state": "NJ",
            "postal_code": "082345549",
            "telephone_number": "609-677-7211",
            "fax_number": "609-677-7210"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2500 ENGLISH CREEK AVE",
            "address_2": "BLDG 200 SUITE214",
            "city": "EGG HARBOR TOWNSHIP",
            "state": "NJ",
            "postal_code": "082345549",
            "telephone_number": "609-677-7211",
            "fax_number": "609-677-7210"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BERGEN",
        "first_name": "BLAIR",
        "middle_name": "ALEXANDER",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-10-18",
        "last_updated": "2008-12-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207V00000X",
            "taxonomy_group": "",
            "desc": "Obstetrics & Gynecology",
            "state": "NJ",
            "license": "25MA04675800",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "3612007",
            "state": "NJ"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Behavioral Crossroads Recovery LLC
• Behavioral Crossroads, LLC (Crossroads Partial Care Program)
• Allen Beier
• Allison Bellino, APN
• Britney Jane Bennett, RBT
• Andrea Lynn Berges
• Dawn M Bermudez, LCSW
• Raymond A. Bernard
• Matthew J Berry, PA-C
• Natali Betancourth, APN

• Obstetrics & Gynecology Physician in Egg Harbor Township, NJ
• Providers in Egg Harbor Township, NJ by specialty
• Obstetrics & Gynecology Physician in New Jersey

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 1, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; facility enrollments, owners and changes of ownership; Provider of Services certification data; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.