Trae Jordan Bergh, PA-C

Primary specialty

Surgical Physician AssistantTaxonomy code 363AS0400X

License

1156 Issued in SD

Practice address

575 N Sioux Point Rd
Dakota Dunes, SD 57049-5312

Phone

(605) 217-2667

NPI assigned

Aug 24, 2018

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

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

{
    "created_epoch": "1535068800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1582588800000",
    "number": "1992286223",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3016 S KEYRELL DR",
            "city": "SIOUX FALLS",
            "state": "SD",
            "postal_code": "571067304",
            "telephone_number": "605-553-6458"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "575 N SIOUX POINT RD",
            "city": "DAKOTA DUNES",
            "state": "SD",
            "postal_code": "570495312",
            "telephone_number": "605-217-2667"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BERGH",
        "first_name": "TRAE",
        "middle_name": "JORDAN",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2018-08-24",
        "last_updated": "2020-02-25",
        "certification_date": "2020-02-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AS0400X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Surgical",
            "state": "SD",
            "license": "1156",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Timothy Baker
• Michael G Bargstadt, MSPT
• Abbey Paige Beck, CRNA
• Tiffany Leann Becker, PT
• Chase Beiermann, PA
• Carmel Berglin, P.A.
• Kaylee Jo Bertrand, RN
• Beth Bruening PC
• Benjamin T. Bissell, M.D.
• William R Blankenship, MD

• All providers in Dakota Dunes, SD
• Surgical Physician Assistant in South Dakota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 25, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.