Jacob Aloysius Bergen

Primary specialty

Behavior AnalystTaxonomy code 103K00000X

License

1-23-66254 Issued in MI

Practice address

6223 N Canton Center Rd Ste 210
Canton, MI 48187-2696

Phone

(734) 203-7675

Fax

(855) 568-2494

NPI assigned

Jul 13, 2018

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

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Practice roles

Locations

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.

• Behavior Frontiers, LLC

  • Behavior Analyst
  • Gardena, CA
  • NPI 1245539394
  NPD

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

{
    "created_epoch": "1531440000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1727136000000",
    "number": "1891271706",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "100 N PACIFIC COAST HWY STE 1400",
            "city": "EL SEGUNDO",
            "state": "CA",
            "postal_code": "902455602"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6223 N CANTON CENTER RD STE 210",
            "city": "CANTON",
            "state": "MI",
            "postal_code": "481872696",
            "telephone_number": "734-203-7675",
            "fax_number": "855-568-2494"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BERGEN",
        "first_name": "JACOB",
        "middle_name": "ALOYSIUS",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2018-07-13",
        "last_updated": "2024-09-24",
        "certification_date": "2024-09-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103K00000X",
            "taxonomy_group": "",
            "desc": "Behavior Analyst",
            "state": "MI",
            "license": "1-23-66254",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Benchmark Physical Therapy Michigan LLC
• Brian Benenati
• Peter Benjamin, MS, ATC, CSCS
• Deborah Bennett
• Natalie Jean Benward
• Ellery Berinstein, MD
• Katie Bernardoni, MD
• Stephaine Rose Berri
• Ali A Berry, MD
• Ann L Berry, AT, PTA, ATC

• Behavior Analyst in Canton, MI
• Providers in Canton, MI by specialty
• Behavior Analyst in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 24, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.