Ma Theresa L. Vanden Berg, M.D.

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

MD60120609 Issued in WA

Practice address

1718 E Kessler Blvd
Longview, WA 98632-1842

Phone

(360) 747-5800

Fax

(360) 575-3846

NPI assigned

Jul 27, 2007

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Other identifiers 3

Other names 1

• Dr. Ma Theresa Concepcion Former name

Medicare fee-for-service enrollment

Enrolled in WA

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

Family Practice

Education

Other, 2001

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Group practices

The Vancouver Clinic Inc PSGroup PAC ID 3173436490, 580 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: mvandenberg12870@tvc-direct.org

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.

• The Vancouver Clinic Inc PS

  dba The Vancouver Clinic

  • Internal Medicine Physician
  • Vancouver, WA
  • NPI 1992759427

  Family Medicine

  Medicare reassignment Care Compare group NPD
• The Vancouver Clinic Inc PS

  dba Salmon Creek 2 Ambulatory Surgery Center

  • Ambulatory Surgical Clinic/Center
  • Vancouver, WA
  • NPI 1306556907
  NPD
• Peacehealth

  dba St. John Medical Center

  • Durable Medical Equipment & Medical Supplies
  • Longview, WA
  • NPI 1639285539
  NPD (past)
• The Vancouver Clinic Pharmacy

  • Pharmacist
  • Vancouver, WA
  • NPI 1336365857
  NPD (past)

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

{
    "created_epoch": "1185494400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1343606400000",
    "number": "1952591711",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 3002",
            "city": "LONGVIEW",
            "state": "WA",
            "postal_code": "986320302",
            "telephone_number": "360-747-5800",
            "fax_number": "360-575-3846"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1718 E KESSLER BLVD",
            "city": "LONGVIEW",
            "state": "WA",
            "postal_code": "986321842",
            "telephone_number": "360-747-5800",
            "fax_number": "360-575-3846"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "VANDEN BERG",
        "first_name": "MA",
        "middle_name": "THERESA L.",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-07-27",
        "last_updated": "2012-07-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "MI",
            "license": "4301089956",
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "WA",
            "license": "MD60120609",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "L & I /CRIME VICTIMS",
            "identifier": "0263926",
            "state": "WA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "500624616",
            "state": "OR"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2008004",
            "state": "WA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "MA THERESA",
            "last_name": "CONCEPCION",
            "prefix": "DR.",
            "credential": "M.D.",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Rafaelani Taruc Uy, M.D.
• Rosamond Claire Valckenier de Greeve, RN, MBA, PHD, MHP, S
• Yarely Valencia-Aguila, R-AAC, BS
• Van Fleet Chiropractic PS
• Vancuver ENT and ENT Opf NW, PLLC
• Weston M Vandenhazel
• Clinton W Vanfleet Jr., DC
• Vickie Vanfossen
• Paiton Vargas
• Veronica Eldora Vargas, LPN

• Family Medicine Physician in Longview, WA
• Providers in Longview, WA by specialty
• Family Medicine Physician in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 30, 2012; 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.

Verify at the official NPI Registry.