Physician Compare National (NPI:1073513982)

HEALTHCARE PROVIDER: JONATHON H BERG MD

Physician Compare National contains general information about individual eligible professionals (EPs) such as demographic information and Medicare quality program participation.

Individual Professional Information
NPI	1073513982
	Unique healthcare provider (clinician) ID assigned by NPPES
PECOS UID	3173506904
	Unique individual clinician ID assigned by PECOS
Professional Enrollment ID	I20040611000275
	Unique ID for the individual professional enrollment that is the source for the data in the observation
Provider Last Name	BERG
	Individual professional last name
Provider First Name	JONATHON
	Individual professional first name
Provider Middle Name	H
	Individual professional middle name
Provider Gender	M
	The provider's gender if the provider is a person.
Provider Credential Text	MD
	The abbreviations for professional degrees or credentials used or held by the provider, if the provider is an individual. Examples are MD, DDS, CSW, CNA, AA, NP, RNA, or PSY. These credential designations will not be verified by NPS.

Medical School Information
Medical School Name	UNIVERSITY OF MINNESOTA MEDICAL SCHOOL
	Individual professional's medical school
Graduation Year	1982
	Individual professional's medical school graduation year
Primary Specialty	FAMILY MEDICINE
	Primary medical specialty reported by the individual professional in the selected enrollment

Practice Information
Organization Legal Name	COOPERSTOWN MEDICAL CENTER
	Legal name of the Group Practice that the individual professional works with- will be blank if the address is not linked to a Group Practice
Group Practice PAC ID	5698687689
	Unique Group Practice ID assigned by PECOS to the Group Practice that the individual professional works with- will be blank if the address is not linked to a Group Practice
Number of Group Practice members	8
	Total number of individual professionals affiliated with the Group Practice based on Group Practice PAC ID
Line 1 Street Address	1200 ROBERTS AVE NE
	Group Practice or individual's line 1 address
City	COOPERSTOWN
	Group Practice or individual's city
State	ND
	Group Practice or individual's state
Zip Code	584257101
	Group Practice or individual's zip code (9 digits when available)
Phone Number	7017972128
	Phone number is listed only when there is a single phone number available for the practice location address

Hospital(s) Affiliation Information
Hospital Affiliation CCN 1	351312
	Medicare CCN of hospital where individual professional provides service 1
Hospital Affiliation LBN 1	NORTHWOOD DEACONESS HEALTH CENTER
	Legal business name of hospital where individual professional provides service 1
Hospital Affiliation CCN 2	351306
	Medicare CCN of hospital where individual professional provides service 2
Hospital Affiliation LBN 2	COOPERSTOWN MEDICAL CENTER
	Legal business name of hospital where individual professional provides service 2
Hospital Affiliation CCN 3	351308
	Medicare CCN of hospital where individual professional provides service 3
Hospital Affiliation LBN 3	NELSON COUNTY HEALTH SYSTEM
	Legal business name of hospital where individual professional provides service 3
Hospital Affiliation CCN 4	351324
	Medicare CCN of hospital where individual professional provides service 4
Hospital Affiliation LBN 4	MERCY HOSPITAL OF VALLEY CITY
	Legal business name of hospital where individual professional provides service 4
Professional Accepts Medicare Assignment	Y