Individual provider Active NPI

Micah Avner Berman, M.D.

  • Otolaryngology Physician
  • Saint Paul, MN
National Provider Identifier
1972747871
Registry record updated Oct 22, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Otolaryngology PhysicianTaxonomy code 207Y00000X
License
59658 Issued in MN
Practice address
200 University Ave E
Saint Paul, MN 55101-2507
Phone
(651) 291-2848
Fax
(651) 602-6885
NPI assigned
Apr 23, 2009
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 22, 2018

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatric Otolaryngology Physician 207YP0228X 59658 MN
Plastic Surgery within the Head & Neck (Otolaryngology) Physician 207YX0007X 59658 MN
Otolaryngology Physician 207Y00000X 59658 MN Primary

Addresses

Primary practice location

200 University Ave E
Saint Paul, MN 55101-2507

Mailing address

200 University Ave E
Saint Paul, MN 55101-2507
Phone (651) 291-2848

Other practice location 1

2211 Park Ave
Minneapolis, MN 55404-3711
Phone (612) 871-1144

Other identifiers 1

IdentifierTypeStateIssuer
H400252166OtherMNMEDICARE PTAN

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MN
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

Enrollment IDStateProvider typePAC IDDetails
I20150612000958 MN Practitioner - Otolaryngology 5799096012 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Otolaryngology
Education
Perelman School of Med at the University of Pennsylvania, 2009
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Ear Nose and Throat Specialty Care of Minnesota PAGroup PAC ID 3274524020, 46 clinicians

Practice addresses (Care Compare)

200 University Ave E
Saint Paul, MN 55101-2507
Phone (651) 291-2848

6099 Wayzata Blvd
Suite 200
St Louis Park, MN 55416-5538
Phone (612) 871-1144

9822 Hospital Dr
Maple Grove, MN 55369-4648
Phone (612) 871-1144

Merit-based Incentive Payment System (MIPS)

Final score
77.11 of 100Reported as group
Quality
63.28
Promoting interoperability
91
Improvement activities
40

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
59658MNMDPediatric Otolaryngology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Ear Nose & Throat Specialty Care of Minnesota PA Otolaryngology CurrentSince Aug 17, 2015 Accepting new patients
Gillette Children'S Specialty Healthcare CurrentSince Oct 12, 2015 Accepting new patients
Gillette Children'S Specialty Healthcare CurrentSince Oct 12, 2015 Accepting new patients
Hennepin Healthcare System, Inc Past Accepting new patients

Locations

9550 Upland Ln N
Ste 200
Maple Grove, MN 55369
Phone (612) 871-1144

3960 Coon Rapids Blvd NW
Ste 104
Minneapolis, MN 55433
Phone (763) 236-9000

2211 Park Ave
Minneapolis, MN 55404
Phone (612) 871-1144

200 University Ave E
Saint Paul, MN 55101
Phone (651) 291-2848

6099 Wayzata Blvd
Ste 200
St Louis Park, MN 55416
Phone (612) 871-1144

Organizations & group practices 4

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.

NPI Registry JSON

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

{
    "created_epoch": "1240444800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1540166400000",
    "number": "1972747871",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "200 UNIVERSITY AVE E",
            "city": "SAINT PAUL",
            "state": "MN",
            "postal_code": "551012507",
            "telephone_number": "651-291-2848",
            "fax_number": "651-602-6885"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "200 UNIVERSITY AVE E",
            "city": "SAINT PAUL",
            "state": "MN",
            "postal_code": "551012507",
            "telephone_number": "651-291-2848",
            "fax_number": "651-602-6885"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2211 Park Ave",
            "address_purpose": "LOCATION",
            "city": "Minneapolis",
            "state": "MN",
            "postal_code": "554043711",
            "country_code": "US",
            "telephone_number": "612-871-1144",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "BERMAN",
        "first_name": "MICAH",
        "middle_name": "AVNER",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2009-04-23",
        "last_updated": "2018-10-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207YP0228X",
            "taxonomy_group": "",
            "desc": "Otolaryngology, Pediatric Otolaryngology",
            "state": "MN",
            "license": "59658",
            "primary": false
        },
        {
            "code": "207YX0007X",
            "taxonomy_group": "",
            "desc": "Otolaryngology, Plastic Surgery within the Head & Neck",
            "state": "MN",
            "license": "59658",
            "primary": false
        },
        {
            "code": "207Y00000X",
            "taxonomy_group": "",
            "desc": "Otolaryngology",
            "state": "MN",
            "license": "59658",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE PTAN",
            "identifier": "H400252166",
            "state": "MN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Saint Paul, MN

Sources for this page

Verify at the official NPI Registry.