MEDICARE: DR. JAMES R BERTSCH D.O.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	02000558A	IN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	000000833338	OTHER	IN	ANTHEM
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1275580532
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JAMES R BERTSCH D.O.

Provider Business Mailing Address
First Line	:	1100 REID PKWY
Second Line	:	MEDICAL STAFF SERVICES
City	:	RICHMOND
State	:	IN
Zip	:	47374-1157
Country	:	US
Telephone Number	:	765-478-6108
Fax Number	:	765-478-1243

Provider Business Practice Location Address
First Line	:	1154 S STATE ROAD 1 STE 1
Second Line	:
City	:	CAMBRIDGE CITY
State	:	IN
Zip	:	47327-9513
Country	:	US
Telephone Number	:	765-478-6108
Fax Number	:	765-478-1243

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/30/2006
Last Update Date	:	05/12/2021

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