Individual provider Active NPI

Michael Scott Bergman, CRNA

  • Certified Registered Nurse Anesthetist
  • Southaven, MS
National Provider Identifier
1972517977
Registry record updated Aug 21, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Certified Registered Nurse AnesthetistTaxonomy code 367500000X
License
58180 Issued in NM
Practice address
7601 Southcrest Pkwy
Southaven, MS 38671-4739
Phone
(662) 349-4000
NPI assigned
Jul 28, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 21, 2024

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

Specialties & licenses 11

Specialty (taxonomy)CodeLicenseStatePrimary
Certified Registered Nurse Anesthetist 367500000X 1322 WY
Certified Registered Nurse Anesthetist 367500000X A810193 MS
Certified Registered Nurse Anesthetist 367500000X 273250-3120 UT
Certified Registered Nurse Anesthetist 367500000X 200860036 OR
Certified Registered Nurse Anesthetist 367500000X AP60225469 WA
Certified Registered Nurse Anesthetist 367500000X RNA-899 ID
Certified Registered Nurse Anesthetist 367500000X D161234 IA
Certified Registered Nurse Anesthetist 367500000X 43557575072 KS
Certified Registered Nurse Anesthetist 367500000X CRNA000533 NV
Certified Registered Nurse Anesthetist 367500000X APRN130636 MT
Certified Registered Nurse Anesthetist 367500000X 58180 NM Primary

Addresses

Primary practice location

7601 Southcrest Pkwy
Southaven, MS 38671-4739

Mailing address

929 Fallen Oaks Dr
Collierville, TN 38017-3540
Phone (901) 853-2336

Other practice location 1

1400 Bellinger St
Eau Claire, WI 54703-5222
Phone (715) 838-5222

Other practice location 2

600 Mt Highway 91 S
Dillon, MT 59725-7379
Phone (406) 683-3000

Other names 1

  • Michael Scott Bergman Other name

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address mbergman2858304@wm.providencedirect.org

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OR, WA, NV, ND, WI, NM, WY, UT8 enrollments

Enrollment records 8

Enrollment IDStateProvider typePAC IDDetails
I20090922000665 OR Practitioner - Certified Registered Nurse Anesthetist (Crna) 7810998135 Reassigns benefits to 1 organization
I20180427002337 WA Practitioner - Certified Registered Nurse Anesthetist (Crna) 7810998135 Reassigns benefits to 3 organizations
I20190114002877 NV Practitioner - Certified Registered Nurse Anesthetist (Crna) 7810998135 Reassigns benefits to 2 organizations
I20190222002215 ND Practitioner - Certified Registered Nurse Anesthetist (Crna) 7810998135 Reassigns benefits to 2 organizations
I20210121001500 WI Practitioner - Certified Registered Nurse Anesthetist (Crna) 7810998135 Reassigns benefits to 1 organization
I20210210000924 NM Practitioner - Certified Registered Nurse Anesthetist (Crna) 7810998135 Reassigns benefits to 1 organization
I20231027000648 WY Practitioner - Certified Registered Nurse Anesthetist (Crna) 7810998135 Reassigns benefits to 2 organizations
I20250211002091 UT Practitioner - Certified Registered Nurse Anesthetist (Crna) 7810998135 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Certified Registered Nurse

State licenses

LicenseStateTypeSpecialty
D161234IAMDCertified Registered Nurse Anesthetist
RNA-899IDMDCertified Registered Nurse Anesthetist
43557575072KSMDCertified Registered Nurse Anesthetist
APRN130636MTMDCertified Registered Nurse Anesthetist
200860036ORMDCertified Registered Nurse Anesthetist
273250-3120UTMDCertified Registered Nurse Anesthetist

Practice roles

OrganizationSpecialtyStatusNew patients
Mountain View Anesthesia LC CurrentSince Feb 24, 2025 Accepting new patients
St Joseph's Hospital and Health Center Current Accepting new patients
Premier Anesthesia of Richland a Division of Premier Anesthesia, LLC Nurse Anesthetist, Certified Registered CurrentSince Apr 1, 2023 Accepting new patients
Western Anesthesia Provider Group-Scherr, P.C. CurrentSince Jun 24, 2019 Accepting new patients
St Alexius Medical Center CurrentSince Nov 12, 2018 Accepting new patients
Mayo Clinic Health System-Northwest Wisconsin Region, Inc. CurrentSince Dec 22, 2020 Accepting new patients
Prosser Public Hospital District of Benton County Current Accepting new patients
Carson Tahoe Physician Hospital Organization, LLC Nurse Anesthetist, Certified Registered CurrentSince Apr 1, 2022 Accepting new patients
Prosser Public Hospital District of Benton County CurrentSince Nov 25, 2024 Accepting new patients
Hot Springs County Hospital District CurrentSince Sep 2, 2023 Accepting new patients
Good Shepherd Health Care System CurrentSince Jan 28, 2014 Accepting new patients
Main Street Anesthesia of New Mexico, LLC CurrentSince Dec 3, 2021 Accepting new patients
St. Joseph's Hospital and Health Center CurrentSince May 25, 2022 Accepting new patients
St Joseph's Hospital and Health Center CurrentSince May 25, 2022 Accepting new patients
Hot Springs County Hospital District Current Accepting new patients
Mayo Clinic Health System-Northwest Wisconsin Region, Inc. Current Accepting new patients
Mayo Clinic Health System-Northwest Wisconsin Region, Inc. CurrentSince Dec 22, 2020 Accepting new patients
Prosser Public Hospital District of Benton County CurrentSince Nov 25, 2024 Accepting new patients
St. Alexius Medical Center CurrentSince Nov 12, 2018 Accepting new patients
Hot Springs County Hospital District CurrentSince Sep 2, 2023 Accepting new patients
Mid-South Anesthesia Consultants, PLLC Past Accepting new patients

Locations

7360 Solutions Ctr
Chicago, IL 60677
Phone (701) 237-8033

200 1st St SW
Rochester, MN 55905
Phone (507) 266-4850

900 E Broadway Ave
Bismarck, ND 58501
Phone (701) 530-7300

2500 Fairway St
Dickinson, ND 58601
Phone (701) 456-4000

3001 Broadmoor Blvd NE
Rio Rancho, NM 87144
Phone (505) 994-7000

117 E 19th St
Roswell, NM 88201
Phone (505) 727-2000

1600 Medical Pkwy
Carson City, NV 89703
Phone (775) 220-9149

2001 Errecart Blvd
Elko, NV 89801
Phone (775) 738-5151

610 NW 11th St
Hermiston, OR 97838
Phone (541) 667-3400

750 W 800 N
Orem, UT 84057
Phone (801) 714-6000

1954 E Fort Union Blvd
Ste 105
Salt Lake Cty, UT 84121
Phone (801) 993-9524

1105 Dale Ave
Benton City, WA 99320
Phone (509) 588-4075

888 Swift Blvd
Richland, WA 99352
Phone (509) 942-2115

733 W Clairemont Ave
Eau Claire, WI 54701
Phone (715) 838-3806

1400 Bellinger St
Eau Claire, WI 54703
Phone (715) 838-3311

150 E Arapahoe St
Thermopolis, WY 82443
Phone (307) 864-3121

Interoperability endpoints

  • Direct secure messaging: mbergman2858304@wm.providencedirect.org

Organizations & group practices 22

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.

View all 22

NPI Registry JSON

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

{
    "created_epoch": "1154044800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1724198400000",
    "number": "1972517977",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "929 FALLEN OAKS DR",
            "city": "COLLIERVILLE",
            "state": "TN",
            "postal_code": "380173540",
            "telephone_number": "901-853-2336"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7601 SOUTHCREST PKWY",
            "city": "SOUTHAVEN",
            "state": "MS",
            "postal_code": "386714739",
            "telephone_number": "662-349-4000"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1400 Bellinger St",
            "address_purpose": "LOCATION",
            "city": "Eau Claire",
            "state": "WI",
            "postal_code": "547035222",
            "country_code": "US",
            "telephone_number": "715-838-5222",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "600 Mt Highway 91 S",
            "address_purpose": "LOCATION",
            "city": "Dillon",
            "state": "MT",
            "postal_code": "597257379",
            "country_code": "US",
            "telephone_number": "406-683-3000",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "BERGMAN",
        "first_name": "MICHAEL",
        "middle_name": "SCOTT",
        "credential": "CRNA",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-07-28",
        "last_updated": "2024-08-21",
        "certification_date": "2024-08-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "367500000X",
            "taxonomy_group": "",
            "desc": "Nurse Anesthetist, Certified Registered",
            "state": "WY",
            "license": "1322",
            "primary": false
        },
        {
            "code": "367500000X",
            "taxonomy_group": "",
            "desc": "Nurse Anesthetist, Certified Registered",
            "state": "MS",
            "license": "A810193",
            "primary": false
        },
        {
            "code": "367500000X",
            "taxonomy_group": "",
            "desc": "Nurse Anesthetist, Certified Registered",
            "state": "UT",
            "license": "273250-3120",
            "primary": false
        },
        {
            "code": "367500000X",
            "taxonomy_group": "",
            "desc": "Nurse Anesthetist, Certified Registered",
            "state": "OR",
            "license": "200860036",
            "primary": false
        },
        {
            "code": "367500000X",
            "taxonomy_group": "",
            "desc": "Nurse Anesthetist, Certified Registered",
            "state": "WA",
            "license": "AP60225469",
            "primary": false
        },
        {
            "code": "367500000X",
            "taxonomy_group": "",
            "desc": "Nurse Anesthetist, Certified Registered",
            "state": "ID",
            "license": "RNA-899",
            "primary": false
        },
        {
            "code": "367500000X",
            "taxonomy_group": "",
            "desc": "Nurse Anesthetist, Certified Registered",
            "state": "IA",
            "license": "D161234",
            "primary": false
        },
        {
            "code": "367500000X",
            "taxonomy_group": "",
            "desc": "Nurse Anesthetist, Certified Registered",
            "state": "KS",
            "license": "43557575072",
            "primary": false
        },
        {
            "code": "367500000X",
            "taxonomy_group": "",
            "desc": "Nurse Anesthetist, Certified Registered",
            "state": "NV",
            "license": "CRNA000533",
            "primary": false
        },
        {
            "code": "367500000X",
            "taxonomy_group": "",
            "desc": "Nurse Anesthetist, Certified Registered",
            "state": "MT",
            "license": "APRN130636",
            "primary": false
        },
        {
            "code": "367500000X",
            "taxonomy_group": "",
            "desc": "Nurse Anesthetist, Certified Registered",
            "state": "NM",
            "license": "58180",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "mbergman2858304@wm.providencedirect.org",
            "affiliation": "N",
            "address_1": "600 Mt Highway 91 S",
            "city": "Dillon",
            "state": "MT",
            "country_code": "US",
            "postal_code": "597257379",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "first_name": "MICHAEL",
            "last_name": "BERGMAN",
            "middle_name": "SCOTT",
            "credential": "CRNA",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Southaven, MS

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 21, 2024; 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.