Jack M Bert MD PA

Primary specialty

Orthopaedic Surgery PhysicianTaxonomy code 207X00000X

License

21554 Issued in MN

Legal business name

JACK M BERT MD PA

Practice address

2025 Woodlane Dr
Woodbury, MN 55125-2987

Phone

(651) 492-6762

NPI assigned

Jul 11, 2011

Organization subpart

No

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

Authorized official

Name

Jack M Bert, MDNPI 1457310542

Title

President

Phone

(651) 491-9303

Specialties & licenses 1

Addresses

Other names 1

• Woodbury Bone and Joint Doing business as

Medicare fee-for-service enrollment

Enrolled in FL, MN2 enrollments

Enrollment records 2

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Jack M Bert, MD

  • Orthopaedic Surgery Physician
  • Woodbury, MN
  • NPI 1457310542
  Medicare reassignment NPD Authorized official
• Michael J Damato, MD

  • Orthopaedic Surgery Physician
  • Saint Paul, MN
  • NPI 1356458988
  Medicare reassignment NPD

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

{
    "created_epoch": "1310342400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1547510400000",
    "number": "1942598016",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2025 WOODLANE DR",
            "city": "WOODBURY",
            "state": "MN",
            "postal_code": "551252987",
            "telephone_number": "651-492-6762"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2025 WOODLANE DR",
            "city": "WOODBURY",
            "state": "MN",
            "postal_code": "551252987",
            "telephone_number": "651-492-6762"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1875 Woodwinds Dr",
            "address_2": "Suite 240",
            "address_purpose": "LOCATION",
            "city": "Woodbury",
            "state": "MN",
            "postal_code": "551252298",
            "country_code": "US",
            "telephone_number": "651-491-9303",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "JACK M BERT MD PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-07-11",
        "last_updated": "2019-01-15",
        "status": "A",
        "authorized_official_last_name": "BERT",
        "authorized_official_first_name": "JACK",
        "authorized_official_middle_name": "M",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "651-491-9303",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207X00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Orthopaedic Surgery",
            "state": "MN",
            "license": "21554",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Woodbury Bone and Joint",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Ryan Lawrence Isaacson, O.D.
• Island Therapeutic Massage
• Linda Kay Iten
• Jennifer Ann Itskovich, MSW
• Josefa Nazareth Izaola-Jovel
• Catherine Jackson
• Heather Jackson, OD
• Latasha Cherelle Jackson
• Shantara Alexandria Jackson
• Avery Jacobs

• Orthopaedic Surgery Physician in Woodbury, MN
• Providers in Woodbury, MN by specialty
• Orthopaedic Surgery Physician in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 15, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.