NPIMap

Individual provider Active NPI

Kimberly Berg, MD

  • Family Medicine Physician
  • Neenah, WI
National Provider Identifier
1962438960
Registry record updated Mar 4, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
39011 Issued in WI
Practice address
1380 Tullar Rd
Neenah, WI 54956-4440
Phone
(920) 727-3480
Fax
(920) 727-3490
NPI assigned
Jun 23, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 4, 2008

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 39011 WI Primary

Addresses

Primary practice location

1380 Tullar Rd
Neenah, WI 54956-4440

Mailing address

PO Box 8003
Appleton, WI 54912-8003
Phone (920) 996-3298

Other identifiers 1

IdentifierTypeStateIssuer
32571300MedicaidWI

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WI
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20040629000684 WI Practitioner - Family Practice 8123004165 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
University of Minnesota Medical School, 1996
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Thedacare, IncorporatedGroup PAC ID 1759294887, 654 clinicians

Practice addresses (Care Compare)

1405 Mill St
New London, WI 54961-2155
Phone (920) 531-2000

1405 S Mill St
New London, WI 54961-2155
Phone (920) 831-5050

2005 Midway Rd
Menasha, WI 54952-7002
Phone (920) 832-8500

2500 E Capital Dr
Appleton, WI 54911-8735

3 Neenah Ctr
Neenah, WI 54956-3070

333 N Green Bay Rd
Neenah, WI 54956-1954
Phone (920) 720-2300

3925 N Gateway Dr
Appleton, WI 54913-7863
Phone (820) 702-6477

4480 W Spencer St
Appleton, WI 54915
Phone (920) 738-4800

600 N Westhaven Dr
Oshkosh, WI 54904-6926
Phone (920) 725-0077

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

Practice roles

OrganizationSpecialtyStatusNew patients
Thedacare, Incorporated Family Medicine CurrentSince Mar 1, 2011 Accepting new patients
Thedacare Medical Center - Berlin, Inc. Past Accepting new patients

Locations

4480 W Spencer St
Appleton, WI 54914
Phone (920) 738-4800

333 N Green Bay Rd
Neenah, WI 54956
Phone (920) 725-2070

1380 Tullar Rd
Neenah, WI 54956
Phone (920) 205-0379

1504 S Commercial St
Neenah, WI 54956
Phone (920) 729-6088

1405 Mill St
New London, WI 54961
Phone (920) 531-2000

600 N Westhaven Dr
Oshkosh, WI 54904
Phone (920) 237-5000

Interoperability endpoints

  • Direct secure messaging: kberg15600@direct.thedacare.org

Organizations & group practices 2

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.

Hospital & facility affiliations 13

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

View all 13

NPI Registry JSON

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

{
    "created_epoch": "1151020800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1204588800000",
    "number": "1962438960",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 8003",
            "city": "APPLETON",
            "state": "WI",
            "postal_code": "549128003",
            "telephone_number": "920-996-3298",
            "fax_number": "920-738-5787"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1380 TULLAR RD",
            "city": "NEENAH",
            "state": "WI",
            "postal_code": "549564440",
            "telephone_number": "920-727-3480",
            "fax_number": "920-727-3490"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BERG",
        "first_name": "KIMBERLY",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-06-23",
        "last_updated": "2008-03-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "WI",
            "license": "39011",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "32571300",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Neenah, WI

Sources for this page

Verify at the official NPI Registry.