Active NPI
Jeffrey Alan Berenson, MD
- Internal Medicine Physician
- Mendocino, CA
National Provider Identifier
1902828619
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Internal Medicine Physician
- License
- G39574
- Practice address
- 45081 Little Lake Street
Mendocino, CA 95460 - Phone
- (707) 937-1055
- Fax
- (707) 937-1061
- NPI assigned
- Jul 24, 2006
- Sex
- Male
- Sole proprietor
- No
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 |
|---|---|---|---|---|
| Internal Medicine Physician | 207R00000X | G39574 | CA | Primary |
Addresses
Primary practice location
45081 Little Lake Street
Mendocino, CA 95460
Mailing address
3536 Mendocino Ave
Suite 200
Santa Rosa, CA 95403-3634
Phone (707) 575-6049
Other identifiers 3
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 00G395740 | Other | CA | BLUE SHIELD |
| 1902828619 | Medicaid | CA | |
| P00872335 | Other | CA | RAILROAD MEDICARE |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in CA
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: Yes
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20071004000872 | CA | Practitioner - Internal Medicine | 2466547419 | Reassigns benefits to 2 organizations |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| G39574 | CA | MD | Internal Medicine Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Attenda Medical Group Inc | Current | Accepting new patients | |
| Adventist Health Mendocino Coast | Current | Accepting new patients |
Locations
700 River Dr
Fort Bragg, CA 95437
Phone (707) 961-1234
3510 Unocal Pl
Ste 207
Santa Rosa, CA 95403
Phone (707) 284-3933
506 S Main St
Sebastopol, CA 95472
Phone (707) 829-5455
Interoperability endpoints
- https://fhir-myrecord.cerner.com/r4/29a5ccea-f4ab-4447-a191-56b20695970f/
- https://app.meldrx.com/api/fhir/Freedom_AMG
- jberenson_amg@amg1500.srs-direct.com
Organizations & group practices 3
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.
-
- Rural Health Clinic/Center
- Fort Bragg, CA
- NPI 1124220249
Hospital & facility affiliations 12
Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.
-
- Home Health Agency
- Fort Bragg, CA
- NPI 1710932157
-
- General Acute Care Hospital
- Santa Rosa, CA
- NPI 1134152549
Hospital
Care Compare profile
Medicare Care Compare- Specialty
- Internal Medicine
- Education
- University of California, San Francisco School of Medicine, 1978
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Telehealth
- Offers telehealth services
- Group practices
- Attenda Medical Group Inc
Practice addresses (Care Compare)
45081 Little Lake St
Mendocino, CA 95460-9517
Phone (707) 937-1055
Hospital & facility affiliations
- Adventist Health Home Care Services
- Adventist Health Mendocino Coast
- Adventist Health Ukiah Valley
- Providence Santa Rosa Memorial Hospital
- Adventist Health Howard Memorial
- Stanford Health Care
Merit-based Incentive Payment System (MIPS)
- Final score
- 80.98 of 100
- Quality
- 73.31
- Promoting interoperability
- 92
- Improvement activities
- 40
- Cost
- 62
Merit-based Incentive Payment System (MIPS)
- Final score
- 75 of 100
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1153699200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1616630400000",
"number": "1902828619",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3536 MENDOCINO AVE",
"address_2": "SUITE 200",
"city": "SANTA ROSA",
"state": "CA",
"postal_code": "954033634",
"telephone_number": "707-575-6049",
"fax_number": "707-937-1061"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "45081 LITTLE LAKE STREET",
"city": "MENDOCINO",
"state": "CA",
"postal_code": "95460",
"telephone_number": "707-937-1055",
"fax_number": "707-937-1061"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BERENSON",
"first_name": "JEFFREY",
"middle_name": "ALAN",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-07-24",
"last_updated": "2021-03-25",
"certification_date": "2021-03-25",
"status": "A"
},
"taxonomies": [
{
"code": "207R00000X",
"taxonomy_group": "",
"desc": "Internal Medicine",
"state": "CA",
"license": "G39574",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BLUE SHIELD",
"identifier": "00G395740",
"state": "CA"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "1902828619",
"state": "CA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "RAILROAD MEDICARE",
"identifier": "P00872335",
"state": "CA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Mendocino, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 25, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; 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.