Thomas Mark Bertagnoli, D.O.

Primary specialty

Pediatrics PhysicianTaxonomy code 208000000X

License

1611 Issued in NE

Practice address

4881 Sugar Maple Dr
Wright Patterson AFB, OH 45433-5529

Phone

(937) 257-9612

NPI assigned

Apr 20, 2015

Last updated

Aug 3, 2023By the provider in NPPES

Sex

Male

Sole proprietor

Yes

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

Enrolled in OH

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

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Osteopathy

State licenses

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

{
    "created_epoch": "1429488000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1691020800000",
    "number": "1912394776",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "88MDG/SGHJ",
            "address_2": "4881 SUGAR MAPLE DR",
            "city": "WRIGHT-PATTERSON AFB",
            "state": "OH",
            "postal_code": "454335529"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4881 SUGAR MAPLE DR",
            "city": "WRIGHT PATTERSON AFB",
            "state": "OH",
            "postal_code": "454335529",
            "telephone_number": "937-257-9612"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BERTAGNOLI",
        "first_name": "THOMAS",
        "middle_name": "MARK",
        "credential": "D.O.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2015-04-20",
        "last_updated": "2023-08-03",
        "certification_date": "2023-08-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "NE",
            "license": "1611",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Keith Thomas Beam, MD, MPH, FACP
• Jodi Annette Bear, NURSE PRACTITIONER
• Theresa Anne Bedford, FNP-BC
• William Neale Bennett V, MD
• Brian T Bentley, DO
• Kimberly Bertrand, PA-C
• John Robert Bettineschi Jr., DDS
• Aditya Avinash Bhagwat, PH.D.
• Melissa Ann Bizzarro, RD,LD
• Darryll W. Black, PA-C

• Pediatrics Physician in Wright Patterson AFB, OH
• Providers in Wright Patterson AFB, OH by specialty
• Pediatrics Physician in Ohio

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 3, 2023; 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.