JACK WILLIAM BERGMAN (NPI# 1043790553) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1043790553 |
| Entity Type | Individual |
| Full Name | JACK WILLIAM BERGMAN |
| Credential | PA-C |
| Practice Address |
3931 Louisiana Ave S St Louis Park MN 55426-5000 |
| Practice Telephone | 9529933230 |
| Practice Fax Number | 9529931748 |
| Mailing Telephone | 9529933230 |
| Mailing Fax Number | 9529931748 |
| Enumeration Date | 2018-08-15 |
| Last Update Date | 2020-01-17 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 363A00000X | Physician Assistant | 13280 | MN | Physician Assistants & Advanced Practice Nursing Providers |
| Address | Telephone Number | Fax Number |
|---|---|---|
| 5838 Six Forks Rd Ste 100, Raleigh, NC 276093893 | 9197853400 | 9197837778 |
| Street Address |
3931 LOUISIANA AVE S |
| City | ST LOUIS PARK |
| State | MN |
| Zip Code | 55426-5000 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1265422927 | Anthony G Bottini | Neurological Surgery | 3931 Louisiana Ave S, St Louis Park, MN 55426-5000 | 2005-10-25 |
| 1437797917 | Allison Marie White | Dietitian, Registered | 3931 Louisiana Ave S, St Louis Park, MN 55426-5000 | 2019-12-16 |
| 1083257612 | Kaylie Marie Laplante | Physician Assistant | 3931 Louisiana Ave S, St Louis Park, MN 55426-5000 | 2019-10-27 |
| 1952960841 | Melissa Ann Moran | Nurse Practitioner | 3931 Louisiana Ave S, St Louis Park, MN 55426-5000 | 2019-06-13 |
| 1205394004 | Maria Kelley Kearney | Occupational Therapist | 3931 Louisiana Ave S, St Louis Park, MN 55426-5000 | 2019-03-11 |
| 1164922910 | Lisa Mary Huset | Physician Assistant | 3931 Louisiana Ave S, St Louis Park, MN 55426-5000 | 2018-02-19 |
| 1184147514 | Avri Ann Bock | Physician Assistant | 3931 Louisiana Ave S, St Louis Park, MN 55426-5000 | 2017-07-18 |
| 1871013037 | Lorraine Marie Richards | Nurse Practitioner | 3931 Louisiana Ave S, St Louis Park, MN 55426-5000 | 2017-06-20 |
| 1336672930 | Naoko Onizuka | Internal Medicine | 3931 Louisiana Ave S, St Louis Park, MN 55426-5000 | 2017-04-10 |
| 1326589011 | Rachel Marie Porteous | Dietitian, Registered | 3931 Louisiana Ave S, St Louis Park, MN 55426-5000 | 2017-03-14 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1821657545 | Big Brain Concussion Recovery & Chiropractic Pa | Chiropractor | 3313 Republic Ave., St. Louis Park, MN 55426 | 2019-06-06 |
| 1912485095 | Daniel Raies | Optometrist | 8900 Minnesota 7, St Louis Park, MN 55426 | 2018-08-01 |
| 1649756040 | Wayside House, Inc. | Clinic/Center | 1349 Jersey Ave S, St. Louis Park, MN 55426 | 2018-07-18 |
| 1104302884 | Superior Caregivers, LLC | In Home Supportive Care | 1319 Lancaster Ave., St. Louis Park, MN 55426 | 2018-07-16 |
| 1396234266 | Caitlin Kwiatkowski | Behavior Technician | 7010 Mn-7, St.louis Park, MN 55426 | 2018-05-07 |
| 1497244313 | Kelly Ann Clancey | Behavior Technician | 7010 Highway 2, Saint Louis Park, MN 55426 | 2018-05-07 |
| 1770072696 | Ashleigh Hakala | Behavior Technician | 7010 Highway 7 St. Louis Park Mn 55426, St. Louis Park, MN 55426 | 2018-05-07 |
| 1689181521 | Glenda Miles | Registered Nurse | 7316 Cedar Lake Road, Apt 8, St Louis Park, MN 55426 | 2017-12-31 |
| 1174041875 | Kristen Webb | Physician Assistant | 3931 Louisiana Ave S, Suite E-500, St. Louis Park, MN 55426 | 2017-09-01 |
| 1447775549 | Belinda Sue Bliss | Marriage & Family Therapist | 3301 Decatur Lane, Saint Louis Park, MN 55426 | 2017-08-09 |
| Find all providers in zip 55426 | ||||
| Taxonomy Code | 363A00000X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Physician Assistant |
| A physician assistant is a person who has successfully completed an accredited education program for physician assistant, is licensed by the state and is practicing within the scope of that license. Physician assistants are formally trained to perform many of the routine, time-consuming tasks a physician can do. In some states, they may prescribe medications. They take medical histories, perform physical exams, order lab tests and x-rays, and give inoculations. Most states require that they work under the supervision of a physician. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1780284844 | Lily Ganz | Physician Assistant | 2737 Huntington Ave, St Louis Park, MN 55416-3917 | 2020-10-28 |
| 1710298336 | Scott Marshall Schmaedeke | Physician Assistant | 1155 Ford Rd Ste B, St Louis Park, MN 55426-1115 | 2010-06-29 |
| 1821075425 | Courtney L Scott | Physician Assistant | 6490 Excelsior Blvd # E500, Park Nicollet Clinic - Meadowbrook, St Louis Park, MN 55426 | 2005-12-27 |
| 1619504768 | Devanie Tucker | Physician Assistant | 3808 Grand Way, St Louis Park, MN 55416-4788 | 2020-03-26 |
| 1083257612 | Kaylie Marie Laplante | Physician Assistant | 3931 Louisiana Ave S, St Louis Park, MN 55426-5000 | 2019-10-27 |
| 1164994133 | Erik Junso | Physician Assistant | 6500 Excelsior Blvd, St Louis Park, MN 55426-4702 | 2019-01-01 |
| 1144790866 | Ashley Marie Overby | Physician Assistant | 5525 Cedar Lake Rd S, St Louis Park, MN 55416-1420 | 2018-11-26 |
| 1164922910 | Lisa Mary Huset | Physician Assistant | 3931 Louisiana Ave S, St Louis Park, MN 55426-5000 | 2018-02-19 |
| 1114435773 | Adam James Uithoven | Physician Assistant | 3850 Park Nicollet Blvd, St Louis Park, MN 55416-2527 | 2018-01-17 |
| 1588177109 | Boris Davydov | Physician Assistant | 4201 Excelsior Blvd, St Louis Park, MN 55416 | 2017-11-06 |
| Find all providers in ST LOUIS PARK | ||||
| City | ST LOUIS PARK |
| Zip Code | 55426 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.